Can someone please explain to me paying for a Dr visit? (USA) oo

Question

I have an appointment tomorrow and this is one of the first visits I will be going to by myself. This is my first time going to this Dr (new family dr) and I went online to figure out how much I will have to pay (I logged in using my insurance info, so this is based on my plan).
I have a health condition and I need to be referred to a specialist. That's what this appointment is for and there's something else I want to bring up as well.
This is what it shows for the Dr I will be seeing. Can someone explain what the difference is between the highlighted purple areas? And maybe help me figure out which one my appointment is? Why would my insurance cover one and not the other? Also, what does the highlighted red area mean?
If I do have to pay, do I have to pay tomorrow at my appointment? Or will they bill me?

UPDATE: I did not pay anything and they did not mention anything about sending me a bill or how much I owe. The Dr wrote me a prescription and had me get blood work done as well. I'm so confused about all this.

Answer

Ok.. so under the affordable care act, all preventive services are covered by insurance 100%—this would be regular well visits to a pcp or gynecologist/ob... regular yearly check ups. If you are going for a “sick visit”—such as to discuss a health issue, then you have to pay. You haven’t met your deductible, so you are responsible for the cost until you do meet it.

Answer

Set preventative services (an annual physical, well women exam) are free of charge.  You’re seeing a specialist and since you’ve yet to meet your deductible you’re paying (the agreed upon rate) with that provider.

Answer

These are two different types of visits. Thats why they are different. Preventative care usually has at least 1 visit a year. Im guessing you havent met your deductible yet, which is why your insurance isnt paying much. I would double check they are in network though. All plans vary on what services they cover and what are considered plan exclusions.

Answer

It will all depend on how the Dr office codes your visit. If they code it as a preventative/wellness exam, it is 100% covered by your insurance. If they code it as anything else, you will have to pay the full amount billed. This is because insurance companies require subscribers to pay everything out of pocket until they meet their deductible (this may take several visits or just one, depending on costs of services and how high the deductible is). After the deductible is fully paid, you'll tupically be respknsible for a percentage of medical costs until ulur "out-of-pocket maximum" is met. Then insurance pays all expenses after that.
Example: if your deductible is $500, upur co-insurance is 20%, and your out-of-pocket maximum is %5000, you have to pay the first $500 of all medical expenses in a given calendar year. If you have more medical expenses throughout the year, you pay 20% of each expense (while insurance pays the rest) until you've paid $5,000. Any expenses after that will be 100% covered by your insurance.

Answer

Your insurance covers one wellness visit. Usually a physical.
If it’s for a sick visit you have to pay $109 because you didn’t meet your deductible. So you pay for your visits out of pocket until that deductible is met and either you are 100% covered or have a coinsurance.

Answer

Some doctors don't accept certain insurances. Are you sure yours accepts your insurance? And they would bill you after the appointment. You pay whenever you can but if a long time passes without paying then they send it into collections. Medical debt doesn't effect your credit though.

Answer

The top one is for a treatment of a specific problem. The bottom one is a routine preventative appointment (essentially a well-visit). Most insurances will cover preventative medicine, but not treatments until you meet your deductible. Since you haven’t met your deductible yet, you have to pay for the treatment visit.

Can someone please explain to me paying for a Dr visit? (USA) oo

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