What is the difference between what the “doctor says” and what the “doctor does”?


Most policies make a distinction between what the doctor says, his consultation, and what he does. The insurance covers the doctor’s consultation, but if he performs a test, that usually isn’t covered under the copay.

For example, let’s say you have a bad sore throat. You go to the doctor. He thinks you may have strep throat. He will perform a test to determine if you have strep throat. The cost of the doctor’s visit is covered under the copay, but the cost of the lab test is not covered under the copay.

The lab test cost would go toward your deductible, but if you are not close to meeting your deductible, you will end up paying out-of-pocket for the lab test.   However, the good news is that you will be paying a discounted price for the lab work.  If you don’t have health insurance coverage, you lab work will typically cost you three times as much.  This surprises many people…they don’t understand that copays don’t cover everything.

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