I’ll address this for individual plans. For group plans the answer will change from group to group.
In general Urgent Care visits are NOT covered by an office visit copay. What happens in most cases is the bill is sent to your insurance company. Assuming the urgent care center is in-network, here is what will happen:
- The urgent care center will send the bill to your insurance company where pricing will be adjusted for network discounts.
- You will receive an explanation of benefits (EOB) from the insurance company
- You will receive a bill from the urgent care center. This bill and the EOB should agree on your responsibility
- The amount shown on the EOB will be applied toward your meeting your annual deductible.
HOWEVER, there is one company that does cover Urgent Care visits with an office visit copay and that would be Humana. They cover Urgent Care visits with the same Copay you would pay for visiting a specialist. Keep in mind, depending on the Humana plan there may be limits on the number of Copays each person has per calendar year.