Health Insurance Deductible Question

[wendow]

Wow, I think you got a great deal out $6000/$12700 plan is $582 per month. The $2500 was like $942 per month with BCBS.

I think the reason ours is so cheap is b/c they changed us to Kaiser. We've never had Kaiser before so it means a change of ALL of our docs. I refuse to use them unless we have to. I love our old docs and have spent YEARS establishing good relationships. Which is another reason I am paying OOP for our docs. So far, every single one has been willing to give us a good discount for a same day cash payment.

 

[wendow]

I work in Health Insurance and this is a HUGE thing we are seeing. Someone goes for a well visit, and during the visit brings up they had a cough, or a rash, ect, and the provider splits the visit in two (without telling the member.) We then have a claim with a well visit AND an office visit billed at the same time and all related diagnosis, and thusly a copay is assigned to the office visit portion.

Yes! As I said in my previous post, we got changed to Kaiser this year from Cigna. I don't think this is just Kaiser but in the info packet we got from Kaiser, it said that basically if you go for your annual physical (which is considered preventative and is 'free') and you bring up any other ailment, you will be charged for a sick visit. That is crazy! So, when I got for my check-up, I'm going to keep my lips sealed unless it's really a problem

 

[LJSquishy]

Okay, so we looked into our plan further...

It looks like very few categories fall under the deductible category. Urgent care, emergency room, and in-patient hospital stays all fall under that category. So, if I haven't met my deductible yet and went to urgent care I would have to pay the $40 copay plus 100% of the bill up until I met my deductible, then pay 20% of the remainder.

So, for us, unless we get sick after normal business hours or have an emergency, meeting our deductible does nothing for us.

 

[C-CMom]

Okay, so we looked into our plan further...

It looks like very few categories fall under the deductible category. Urgent care, emergency room, and in-patient hospital stays all fall under that category. So, if I haven't met my deductible yet and went to urgent care I would have to pay the $40 copay plus 100% of the bill up until I met my deductible, then pay 20% of the remainder.

For us, we wouldn't ay a COPAY on a visit that is subject to a DEDUCTIBLE, it would be either/or. Basically, would pay 100% of the negotiated in-network rate until deductible met, but would not owe an "extra" $40. When copays are paid they are typically taken out of the amount due, not added as an extra amount.

Also may want to check if there is a "Copay Maximum" for your plan. A plan might require quite a few visits to reach that amount, but if someone had a condition that required multiple specialist visits for example, there may be a maximum of these copays that will add up. After that, the plan may cover 100% even on the office visit category. The COPAY MAXIMUM is different from the DEDUCTIBLE (for the categories I previously described).

And other plans may differ even more...

Good luck.