You see the specialist and refill both of your prescriptions. Your February copayments are $60 + $25 + $45 = $130. But the endocrinologist also orders a series of tests and labs, which aren't covered by the specialist office visit copay, since they're instead counted towards your deductible. You end up paying $240 for the tests, and that counts. Depending on the insurance plan of the mental health patient, that new patient will need to pay a recurring fee to their insurance company as will probably need to pay you a small sum in person to see you as a specialist. The amounts of each are determined by their behavioral health insurance plan. Almost all private insurance policies require the insured person to pay a co-pay when visiting a doctor or any other health care provider. The co-payment amount varies depending on the insurance plan. Typical co-pays for a visit to a primary care physician range from $15 to $25. Co-pays for a specialist will generally be between $30 and $50.
| Basic Option | |
|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services |
| Physician Care | $30 for primary care1 |
| Virtual doctor visits by Teladoc® | $0 for first 2 visits |
| Urgent Care Center | $35 copay |
| Prescription Drugs | Preferred Retail Pharmacy: Tier 1 (Generics): $10 copay Tier 2 (Preferred brand): $55 copay2 Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2 Tier 4 (Preferred specialty): $65 copay2 Tier 5 (Non-preferred specialty): $90 copay2 Mail Service Pharmacy: Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Tier 1 (Generics): $20 Tier 2 (Preferred brand): $100 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy: Tier 4 (Preferred specialty): $85 copay2 Tier 5 (Non-preferred specialty): $110 copay2 |
| Maternity Care | $175 inpatient $0 outpatient |
| Hospital Care | Inpatient (Precertification is required): $175 per day; up to $875 per admission Outpatient: $100 per day per facility1 |
| Surgery | $150 in an office setting1 $200 in a non-office setting1 |
| ER (accidental injury) | $175 per day per facility |
| ER (medical emergency) | $175 per day per facility |
| Lab work (such as blood tests) | $0 copay1 |
| Diagnostic services (such as sleep studies, CT scans) | Up to $100 in an office1 Up to $150 in a hospital1 |
| Chiropractic Care | $30 per treatment; up to 20 visits per year |
| Dental Care | $30 copay per evaluation; up to 2 per year |
| Rewards Program | Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Online Health Coach goals3 |
Two rewards you can earn:
- Free PCP visits:
- To earn free PCP visits, select a PCP, and
- Complete the RealAge® test (an online health assessment that helps you determine the physical age of your body compared to your calendar age.)
- $5 reduction to your specialist copay:
- To receive a $5 reduction in your specialist copay, complete one of the recommended screenings listed in the State of Maryland Wellness Plan Activities (PDF).
The $5 reduction to your specialist copay will be activated after CareFirst receives a verified paid claim. The claim must meet certain requirements including having gone through the CareFirst claims review process and have been paid. CareFirst will update the member's account to show the $5 copay reduction has been granted. The entire process may take up to 45 days.
Aetna Specialist Copay
To access the above activities, simply log in to your Sharecare account, click Achieve, then Rewards. Next, click State of Maryland Wellness Program 2021. The sooner you complete your wellness plan activities, the sooner you start saving. If you require assistance with the wellness program or completing any activity, call Sharecare at 877-260-3253.
Specialist Copay
*Sharecare, Inc. is an independent company that provides health improvement management services to CareFirst members. Sharecare, Inc. does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the health improvement management services it provides.