Not covered because you have a deductible to pay? Health Insurance question!?

Question

I was trying to get covered by a doctor (need to see doctor before I can get surgery), but when he called my insurance company he said that I had a deductible so I had to pay out-of-pocket. What the heck does that mean? If I don't pay the full deductible will they deny me for surgery? Is the guy just not covered? I thought you had a full year to pay! What can I do? (Paying O.O.P anyway)

Answer 1

If you have a deductible, you should NOT be paying out of pocket FIRST. Your insurance should be billed, and then the provider will be told by the plan how much to bill you. That is how the plan tracks how much goes to your deductible and when the deductible is met. (It usually also works out cheaper for you because you generally don't pay the billed amount, you pay what the insurance would have paid the provider.)

Now, that said, the rules might be different for a doctor who does not participate in your plan. Call the member services number on the back of your card to find out if that doctor was participating or not.

Where did you get the idea of a full year to pay? To pay what? Your bill? That is between you and the provider. (My office generally gives 90 days unless you make arrangements.) You have to meet your deductible within the year for the insurance to pay anything afterwards.

Answer 2

If you have a deductible, you must pay cash for everything before the insurance company will pay anything. This is different that out of pocket. Say you have a $500.00 deductible and your insurance company pays at 90%. You go to the doctor for an office visit and he charges $100.00 for a visit. You must pay the $100.00 just as if you were a cash patient for 5 visits before the insurance company will pay for the 6th visit. But it only pays $90.00 Because your out of pocket is 10% So you get a bill for 10.00 for every visit after that. This happens every year. You should not be denied surgery because you have not met your deductible. You just have to pay the $500.00 first. You might want to be sure that the doctor is in network because if you use an out of network doc the ins compay will only pay at say 60% Then your out of pocket will be 40.00 per visit. Hope this helps.

Answer 3

It means that you pay less per month for health insurance but when you need to use it, you have to pay the deductible first (a lump sum payment) before your insurance begins to kick in and pay the doctors or any other bills associated with your surgery. The surgery you are seeking has to be a covered by your insurance, too, and usually approved in advance when elective.

I went through the same thing a few years ago. Had to write out a check to pay my deductible before being admitted into the hospital and scheduling the surgery.

Answer 4

Well, the insurance doesn't kick in until your deductible has been paid. The deductible gets paid straight to the provider. If the doctor doesn't want to wait a year to collect money from you, well, he's not going to provide you with these services.

You STILL need to submit those out of pocket bills to the insurance company, so they can see you paid - it goes towards your deductible.

Answer 5

That means you have to pay out of pocket a certain amount until you have reached that limit. Say you have a $500 deductible. If your doctor visit is $200 you pay that up front. Then you have $300 left to pay. Your next visit is $300 and you pay that. Then you are covered at 100% and will not have to pay anymore.

Answer 6

Did your agent explain you the deductible before you bought the policy?

Deductible works this way:
Supposing you buy policy with $5,000 deductible, and you get medical bill of $8,000, you have to pay $5,000 from your pocket and you can claim the rest ($3,000) to your insurance company.

There are several kinds of deductible: per year, per case, etc. You should check this by reading your contract, and asking your agent or Customer Service department of your insurance company.

You might have to bear co-insurance (i.e. the part of medical bill you have to bear above deductible) also.
Using the above example, supposing your medical bill is $8,000, deductible is $5,000, and co-insurance 10%, here is the computation:

Bill : $8,000
Deductible : $5,000
____________________ -

$3,000
Co-ins 10% $ 300
____________________-

Claimable Amt $2,700

You have to pay $8,000-$2,700 = $5,300

The most important thing in buying insurance is: think carefully before you buy.

Answer 7

definite, you do pay a deductible. in case you get team wellbeing that could have a low deductible or none. this is the out of pocket volume you pay each and every 3 hundred and sixty 5 days in the previous the coverage covers their 80% of rates.

Answer 8

Call your insurance company, ask them if the deductible is for your in-network benefit. Make sure the doctor is on the plan. the deductible may be for out of network only... It may be your in network benefit. It may be your only benefit for this service. Once you satisfy the deductible, you will be responsible for the percentage defined in your policy.