jacodaro said:
Does the insured receive repriced office visits with Assurant when visits are not included in the coverage? How does that work?

Not sure exactly what you're asking, but if office visits aren't included with the coverage, then the insured just pays for the office visit out of pocket. Whatever that particular doctor's office charges.

What you're asking if the difference between the copay vs. no copay options. Yes, the visits get re-priced as long as it's a covered visit. Take the Max Plan - you can take away the copay option and all visits are re-priced including wellness within the 1st 12 months. However, take the CoreMed plan - visits for illness are re-priced without the copay option but not for wellness within the 1st year since it's not a covered expense.
Yes, that's what I meant. Co-pay or no co-pay. If it would have been covered had there been a co-pay option taken it will be repriced. Now, how do you explain that to the client? Do they go for an office visit and pay nothing and wait for a bill or pay something up front? Thanks so much.
Yes, they pay nothing until they get a bill - just like a HSA. Now, there have been occassional snags with some doctors in the past. Some doctors require either the copayment or payment in full at the time of service. My HSA clients have explained to the receptionist that they have a HSA and the bill has to be network re-priced first - which results in a dull glazed-over stare back from the receptionist. I've seen two outcomes; one where they just say ok and the client gets billed. But I've already had a few scenarios where the doctor demands some type of payment or estimated payment before the client leaves. Just depends on the doctor's knowledge of no-copay plans, how bad he's been burned by clients not remitting payment and his knowledge of network re-pricing.
That kept on happening to me too, with HSA clients. I started to tell them to just offr the copay themselves, and when the reduction is returned to the office, they just apply it to the balance.
If the claim is filed with the carrier, and the visit is for a medical condition that is excluded by rider, there is no repricing. If the claim is for prenatal care, and the policy does not have a maternity benefit, there is no repricing.