Which statement describes how a major medical expense policy typically pays surgeon fees?

Which statement describes how a major medical expense policy typically pays surgeon fees?

• A. It pays surgeon fees on a first-dollar basis.
• B. It does not pay surgeon fees on a first-dollar basis.
• C. It pays surgeon fees only for in-network procedures.
• D. It pays surgeon fees only after a separate surgical rider.

Answer: (B)

In a major medical expense policy, benefits are provided through cost sharing rather than paying the bill in full right away. You must meet the deductible first, and then the plan typically covers a portion of the remaining eligible charges as coinsurance, up to the plan’s limits. Because of this structure, surgeon fees are not paid on a first-dollar basis—the insurer doesn’t cover the full surgeon charge from the start. Instead, payment depends on after-deductible coinsurance and the plan’s allowed amounts, and may vary for in-network versus out-of-network services. A separate surgical rider isn’t required for the standard major medical benefit, since surgeon fees are handled through the usual deductible and coinsurance framework.

In a major medical expense policy, benefits are provided through cost sharing rather than paying the bill in full right away. You must meet the deductible first, and then the plan typically covers a portion of the remaining eligible charges as coinsurance, up to the plan’s limits. Because of this structure, surgeon fees are not paid on a first-dollar basis—the insurer doesn’t cover the full surgeon charge from the start. Instead, payment depends on after-deductible coinsurance and the plan’s allowed amounts, and may vary for in-network versus out-of-network services. A separate surgical rider isn’t required for the standard major medical benefit, since surgeon fees are handled through the usual deductible and coinsurance framework.