Depending on your plan, visits to certain doctors may or may not qualify for primary care office visit copays. For example, PPO members pay primary care office visit copays if they go to family practice or internal medicine physicians, or other primary care practitioners within the network. But if they get care from a specialty care practitioner, such as a dermatologist or gastroenterologist, that would be a specialist office visit copay.
Primary care visit to treat an injury or illness $20 copay per visit 40% of Allowed Benefit No visit limits. Specialist visit $40 copay per visit 40% of Allowed Benefit Certain therapeutic services limited to a 90-visit maximum, per therapy, per calendar year. Covered services paid at 100% minus copays $ 5 Primary Care Physician (PCP) copay; $35 Specialist copay; $50 Urgent care facility copay; $300 Emergency Room (ER) admittance copay (ER copay waived if admitted to the hospital) $250 copay per hospital stay; $250 copay for outpatient surgery when in hospital setting, no copay for free standing facility.
HMO members can only get the primary care office visit copay if they go to their primary care physician.
Select your plan type below to see which kinds of doctors qualify for a primary care office visit copay.
Not all health care services are created equal. A routine visit to your family doctor’s office is much different than a trip to a specialist, so it makes sense that they wouldn’t cost the same. Our plans with tiered copays connect the amount you pay to the type of care you receive. Torrent iskysoft pdf editor pro for mac.
What does this mean for me?
If your plan offers tiered copays, you’ll find a few kinds of payments when you pay for your health care. The lowest copays will be for office visits to a primary care physician, physician’s assistant or nurse practitioner. If you need to visit urgent care or see a specialist like a cardiologist or an immunologist, your copay will be a little higher. The most expensive copays will come when you visit the emergency room.
What primary care physicians and practitioners are in the lowest tier of copays?
There are many doctors and practitioners with a primary care specialty. An office visit to any of the following kinds of health care professionals will be in the lowest tier of copays:
Family practice
- Adolescent medicine
- Family practice
- Geriatric medicine – Family practice
- General practice
- Family nurse practitioner
- Preventive medicine
General practice
- Adolescent medicine
- Family practice
- General practice
- Public health / General preventive medicine
- Preventive medicine
Geriatric medicine
- Geriatric medicine – Family practice
- Geriatric medicine – Internal medicine
Internal medicine
- Adolescent medicine
- Geriatric medicine – Internal medicine
- Internal medicine
- Internal medicine – Pediatrics
Pcp Copay Definition
Obstetrics and gynecology
- Obstetrics and gynecology
- OB/GYN nurse practitioner
Pediatrics
- Adolescent medicine
- Pediatrics
- Pediatric nurse practitioner
Nurse practitioner
What Is Pcp Copay
- Certified nurse practitioner
- Family nurse practitioner
- OB/GYN nurse practitioner
- Pediatric nurse practitioner
Physician assistant
- All provider specialties
Tiered copays are not available for all Blue Cross Blue Shield of Michigan health plans. Check your plan riders or call the phone number on the back of your member ID card to find out if your plan has tiered copays.