Health Insurance Experts...?

[AKL_Megs]

My DH's insurance just changed, it's supposed to be "better", but I am not sure.

He doesn't pay anything per month, but we have a $3000 family deductible. I don't think I've ever seen this before, but below the deductible info it says, "Note: Deductible waived if service is performed in a PPO physician's office."

What exactly does that mean? Anything short of a hospital is free?

 

[Tinkmom75]

You may have a copay for office visits etc as long as they are in network. deductible is applied if you go out of network. The HR department should have a sheet explaining fees.

 

[bicker]

We have a real $2000 deductible here... our company reimburses us for the $2000 though.

 

[LuvOrlando]

Sounds to me like fees are waived if you stick with a mega-mart Dr who has in-house lab services, x-ray ect.

The flip side of this is people are penalized if they go elsewhere which means stand alone facilities will be hard hit by the losses if these practices gain system-wide popularity. This begs the question of why? Assuming an insurer would pay the same fees to all facilities that participate why reward a client for staying in an office and penalize for going outside? Must be something behind it. Sounds like a HMO with an escape clause. Do you have an out of pocket maximum?

 

[bicker]

Generally, with everything in-house, there is more control over costs. Cost-control is a big issue with health insurance these days. It does often adversely impact quality of care, and insureds would prefer insurance that doesn't have such restrictions, assuming that they didn't have to pay a lot more for it. Therein lies the rub: These clauses often differentiate high price from low price, as well as they differentiate high quality from low quality.

 

[mhsjax]

We have a ppo and nothing is done in house, it isn't allowed. OP, I would check with HR for clarification.

 

[DisneyBamaFan]

My PPO has a deductible for "in plan" doctors, and a higher deductible for "out of plan" doctors. Sounds like the same thing, but your "in plan" deductible is $0 - good for you!

Still, with a PPO, you probably still have to pay something for the visit, a percentage or co-pay. I would call and make sure that you understand your plan so you have no unexpected bills.

 

[manning]

This will explain PPO

http://www.finweb.com/insurance/what-is-ppo-health-insurance.html

 

[Piecey]

If it's like our insurance it means that if you go to a PPO Dr. On January 1st you only pay a copay even though you haven't met deductible. We have a 700$ family deductible and didn't meet it until September of this year when our 3 week old was admitted. Maternity-well child- outpatient doctor care all had the 'no deductible' clause too. Definitely check with hr or the insurance company themselves to clarify though. I find some of their lingo to be confusing.

 

[Nancy]

Sounds to me like fees are waived if you stick with a mega-mart Dr who has in-house lab services, x-ray ect.

The flip side of this is people are penalized if they go elsewhere which means stand alone facilities will be hard hit by the losses if these practices gain system-wide popularity. This begs the question of why? Assuming an insurer would pay the same fees to all facilities that participate why reward a client for staying in an office and penalize for going outside? Must be something behind it. Sounds like a HMO with an escape clause. Do you have an out of pocket maximum?

The doctors probably have a much better contracted rate going on. Insurance doesn't pay the same rate to all facilities/doctors..they all draw up their own contracts and negotiate their reimbursement.

I do see this clause a lot on plans that have both co pays and deductibles.

It can be a bit deceiving. The benefit for out patient lab will say if done in the office no deductible, but if you go to an outpatient lab there is a deductible. What it doesn't say is even if the doctor draws your blood and sends it somewhere that is not being done in the office. The lab is going to bill the tests as outpatient labs..and the doctor will just bill a small fee for doing the collection.

 

[AKL_Megs]

Thanks All!

I called BCBS yesterday, and it seems we have a deductible that is paid for by DH's city (he's a police officer), and we pay 20% of anything OVER that. So, pretty normal, only he first $3000 is covered! Very nice!!!