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Questions and answers


Payments and deductibles
Billing
Summary of Accumulation or Explanation of Benefits
Emergency care
HRA, HSA, and FSA
For more information

Payments and deductibles


Q. How much is my deductible?

A. You can find the exact amount of your deductible in the benefit summary or Evidence of Coverage (EOC) that you received during your open enrollment period. You can also call the number on your Kaiser Permanente ID card or visit the "My Benefits" page of the Estimates tool

Q. Why do I seem to have to pay a different amount each time I come in for a visit?
A.
The amount you pay at check-in will vary depending on the services you’re scheduled to receive. With a deductible plan, you'll pay the full charges for services covered by your plan until you reach your deductible. After you reach your deductible, you'll start paying less — a copay or coinsurance for covered services, depending on your plan benefits. In most cases, what you pay when you check in will only cover part of what you owe for your scheduled services. If so, you'll get a bill for the difference later.

Q. Do all payments count toward my deductible?
A.
Not all payments count toward your deductible. Depending on your plan, some services only require a copay or coinsurance and those copays and coinsurance count toward your out-of-pocket maximum.

Q. Do copays, coinsurance, and deductible payments count toward my out-of-pocket maximum?
A.
In most cases, yes. However, there may be certain exceptions, such as payments for infertility services, which typically do not count toward the out-of-pocket maximum.

If you have an HSA-qualified deductible plan, payments for all services covered by your plan will count toward your out-of-pocket maximum.

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Billing


Q. Before my visit, can I find out how much I’ll need to pay?
A.
 Yes. For your convenience, we offer a couple of ways to get an estimate of your expected charges: 

  • Use our Estimates tool, which provides personalized online estimates for more than 400 common services and procedures.
  • If you can't get an estimate for a service online, call 1-800-390-3507, weekdays from 7 a.m. to 5 p.m.

Remember that estimates are based on the scheduled appointment type or service that you identify, and may not be exactly what you’ll owe for your visit — especially if your doctor decides that you need additional services that weren’t scheduled before your visit.

Q. Why can’t you tell me the total amount I owe for my visit when I check in?
A.
We may not know exactly which services you’ll receive until you see your doctor. If you receive services during your visit that weren’t already scheduled, the charges for these additional services will appear on the bill you get at home (minus the payment you made when you checked in).

Q. I got a cost estimate before my visit, but was charged a different amount at check-in. Why?
A.
The estimates you get from our Estimates tool or over the phone are based on the scheduled appointment type or service that you identify. However, the amount you pay at check-in may only cover part of what you owe, especially if you get unscheduled services during your visit. In that case, you'll get a bill for the difference later.

Q. I paid when I checked in for my appointment. Why did I get a bill later for additional charges?
A.
 What you pay at check-in may only cover part of what you owe, especially if you get unscheduled services during your visit. Your doctor may arrange for additional services (like a blood test or an X-ray) after seeing you, so the actual cost of your visit may be higher. If there are any additional charges, you’ll get a bill for the difference later.

Q. I went in for a preventive care visit that was supposed to have no charge. Why did I get a bill later?
A.
During a preventive care visit, you may receive both preventive and non-preventive care services. If so, you’ll probably be charged for these additional non-preventive services. For example, during a routine physical exam your doctor might decide that a mole needs to be removed for testing. Because mole removal and testing are considered non-preventive care services, you'd probably have to pay an additional copay, coinsurance, or deductible payment for these services. These extra costs would appear on your bill later.

Q. I paid for care, but I don’t see it on my bill. Why?
A.
Services and related payments may take up to 125 days to appear on your bill. If recent charges or payments don’t show up on your current bill, you’ll see them on a future bill. In most cases, our claims are processed on average within 45 days.

Explanation of Benefits


Q. What’s the difference between a bill and my Explanation of Benefits (EOB)?
A.
Your EOB isn’t a bill. It's a summary that shows the services you received, how much they cost, and how much your health plan paid. Use it to keep track of your expenses, your deductible, and your out-of-pocket maximum. That way, you can see how close you are to reaching those limits. It may take about 30 days for services to show up on your EOB. 

You can also see your EOBs online at kp.org/mydocuments.

Emergency care


Q. If I’m out of my home area and need emergency care, will this be covered?
A.
Yes. Emergency care is covered outside your usual service area. You’ll pay a deductible payment or, if you’ve met your deductible, a copay or coinsurance for emergency services. See your Evidence of Coverage for details. 

For more information

Q. Where can I get more information about my health plan?
A.
For additional information about your deductible plan or your benefits, just call our Member Service Contact Center at 1-800-464-4000, 24 hours a day, 7 days a week (closed holidays). For TTY for the deaf, hard of hearing, or speech impaired, call 1-800-777-1370.

Q. Where can I get more information about my HRA, HSA, or FSA?
A.
For specific information about your HRA, HSA, or FSA, call Kaiser Permanente Health Payment Services at 1-877-761-3399, Monday through Friday from 5 a.m. to 7 p.m. (Pacific time). Closed holidays.


*A qualified medical expense is defined under Internal Revenue Code Section 213(d). If your employer offers you an HRA, the qualified medical expenses that you can pay for with your HRA, may vary. Check with your employer's plan administrator for details. To view the entire list of qualified medical expenses download IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications.

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