health insurance deductibles, please explain?

Question

https://www.highmarkbcbs.com/cgi-bin/inetcgi/directpay/actions/ViewQuotes.do



THAT IS THE LINK TO MY COVERAGE TO BETTER HELP YOU EXPLAIN WHAT IS COVERED. SORRY FOR BEING SO IGNORANT ABOUT THIS. IT'S JUST REALLY CONFUSING.

Ok, I just got healthcare insurance. My deductible is 1200.00. What exactly does that mean? I have a "new patient" visit scheduled with a physician. Does this mean that I have to pay out of pocket for all doctor's visits up to $1200.00? How does my insurance company even know how much I have accumulated? What happens if I rarely see a physician? These are reasons I have declined insurance for many years, because I was worried that my premiums ($149.00) will just be spent on the "chance" I might get sick, and then when I do, I will still have to pay $1200.00 out of pocket before the insurance ever kicks in. I'm pretty healthy and it would take many pcp visits to accumulate $1200.00. THANKS FOR YOUR ANSWERS.

Answer 1

DO NOT PAY THE DOCTOR UP FRONT! Let them bill the insurance first. Reason being - doctors can, in theory, bill whatever they like. What they get paid by an insurance company is a completely different matter. It's called "contracted rate" = meaning, it's a prenegotiated rate that's agreed upon between the doctor and the insurance company. A cash-paying patient usually pays more. For example - my office bills $80 for a general office visit. Insurance companies pay anywhere from $15-$35, plus the copay. (which is anywhere from $5-$25 - often, the more the patient pays, the less the plan does.) Now, if someone has a plan where this visit was to go to the deductible, the insurance would tell us to bill the patient, let's say, $55.01 = which is what the insurance would pay once the deductible is met. By the doctor's office billing the insurance first, not only do you not have to pay out the wazoo, the insurance will track how much goes towards your deductible.

I have to tell you - $149 a month for insurance with a deductible is pretty good. Especially since chances are you're not going to meet the deductible that often, if ever. If your company offers what they call an HSA - a Health Savings Account - try to get in on that. That's where they take a portion of your pretax dollars and set them aside to use for medical expenses (you usually get a debit-type card) that the insurance doesn't cover - like deductibles. The only drawback is = at the end of the year, whatever money you don't use, you lose.

To expand on what Phoenix said - catastrophic medical bills can, and often do, bankrupt a person. A simple hospital stay can be $10,000 a day. I know someone who's stepson had cancer - they had good insurance and still ended up nearly a million dollars in debt for his treatment. Once you meet the deductible, you should not have much, if anything else out of pocket - since it's such a high deductible. (The only thing she was a little off about was the copay part - not everyone has copays, some plans have copays for office visits, but a separate deductible for any procedures like bloodwork or throat cultures. Some plans have deductibles for the hospital only, some have a deductible only if you go out of network. There's literally hundreds of thousands of plans out there with different variations. )

I hope this cleared things up for you. Good luck! Stay well. =)

Answer 2

1

Answer 3

Generally, there is a copay for regular visits and the deductible is for things like a hospital stay, certain lab work, etc. You would have to pay $1200 in the event that you had medical expenses beyond a normal doctor's visit, before the insurance would pick up any of the tab.

Medical offices send all claims in to your insurance, whether you pay all of it or the insurance does. If you rarely see a doctor, a healthcare savings account (a special tax-free account) may be a better option for you. The main reason for having insurance is in the event that something catastrophic happens. Medical bills can be outrageous, so paying that little bit of premium is often far more economical.

Answer 4

Phoenix is right. After you have paid the $1200 deductible, usually you pay 80% and the insurance covers 20% until you hit your max. out of pocket for the year. Your link didn't work so I can't see exactly what your quoted coverage is. Some insurance plans have a drug card where prescribed drugs only cost $10 or some other small amount. Other plans put the prescriptions towards the deductible.

Answer 5

Listen to Phoenix, she is right on.

Answer 6

i like it