What you need to know

What is the significance of not paying a co-pay at time of service?

Each time a CDHP member goes to the doctor, he or she should present the medical ID card provided by their health plan. In most cases, patients won’t pay for the service on the spot, like they would with most traditional health plans. Instead, the doctor will submit the bill to the health insurance provider. The insurer then adjudicates (processes) the claim and sends the member an EOB telling them how much they owe for the service. At this point, the member calls the doctor’s office and provides their healthcare account debit card information or files a paper claim for reimbursement.

Depending on the structure of their plan, members may be required to pay a discounted rate for prescription drugs they purchase at the pharmacy. For example, if they are enrolled in a QHDHP and have not met their annual deductible, they are required to pay for the medication at the pharmacy. In this case, they should pay with their debit card and keep their receipt to either give to their healthcare account administrator to keep for record-keeping purposes, in case they are ever audited by the IRS.

Key points to remember when using a QHDHP:

  1. Present your medical ID card every time your access medical services or products. Without it, you will pay retail when you are entitled to wholesale costs, which are negotiated by your health insurance carrier.
  2. Never pay for medical services at the doctor’s office, even if the receptionist asks that you do. If your doctor participates with your health plan, they have a contract with your insurance company that requires them to give you a pre-negotiated discount, which will be calculated through your insurer when they adjudicate claims.
  3. Pay for medical services after you receive your EOB—you are paying the total amount listed on your EOB, not your doctor’s bill, and there may be significant differences between the two.
  4. You may be asked to pay the discounted price of a drug at the pharmacy. In this case, pay with your healthcare account’s debit card if available, or submit the bill to your healthcare account administrator for reimbursement.

Coaches' Takeaway

Familiarity of how the process works on both the patient and doctor’s end.

Tools & Resources

CDHPCoach’s Storage Facility, where the Coach has organized and compiled a vast amount of tools and resources for you to access.


Housed here are key components and information within the book, Bend the Healthcare Trend which was the impetus behind the CDHPCoach.


What you need to know