Question

Mary Berry has an HMO care insurance with a $20 copay. If the charges are $250 how much will the patient pay?

Answer 1

A Health Maintenance Organization, or HMO, is a network of healthcare providers who agree to provide services at lower prices negotiated by an insurance company.

Members choose a single physician from a list of approved healthcare providers. HMO members HMO can only see a health care specialist such as an obstetrician, rheumatologist, cardiologist, etc. if they get a referral from their Primary Care Physician (PCP), who is also known as the gatekeeper.

Various services/benefits provided by an HMO can differ depending on the company and the health plan. It may cover health screenings, cancer screening, prescribed medications, laboratory tests, X-rays, and other scans. HMOs usually cover prenatal care and well-baby care.

A copay, short for copayment, is a fixed amount a healthcare beneficiary pays for covered medical services. The remaining balance is covered by the person's insurance company.

Mary Berry pays these fixed amounts for those services regardless of what the services actually cost. The insurance company pays the remaining balance (the "covered amount"). Therefore,Mary Berry's costs $250, the patient pays $20, and the insurance company pays $230.