Wait, why do I owe patient responsibility?

An age-old (and frustrating) question after doctor's appointments...

Most common reason

Your deductible hasn't been met for a sick visit

The unfortunate reality is that for all types of sick visits (i.e., anything that isn't specifically a well-child visit), most insurance companies will not cover any of the cost until your deductible has been met. This can be confusing because a co-pay is often visible on your insurance card (say $20), but your insurance plan will pass on a much higher cost to you after the claim has been processed (the "patient responsibility").

In these cases, we are contractually required to bill you the patient responsibility that the insurance company determines. The amount can vary depending on the nature of the visit and your specific health plan, but the typical out-of-pocket cost for a sick visit is in the $100-$150 range.

Less common reason

Your insurance company refuses to cover certain clinically important procedures

Thankfully this is less common, but some insurance companies refuse to cover procedures that are clinically important and pass along the cost to you as patient responsibility. A typical example of this is the postpartum depression screener. The research tells us that it's important for pediatricians to screen parents for postpartum depression in the months after a child is born, but some insurance plans have a different view.