If health insurance company tells you they will pay 100% of all medical bills after the deductible....?

Question

Are they telling the truth? Are there any hidden exceptions? BTW, the insurance I am joining is Humana One.

Answer 1

They will pay 100% of the covered charges, which means if a procedure is not covered it won't be paid. This will include any pre-existing conditions or riders that are with the policy. You'll need to look at the exclusions on the policy to see what is not covered.

Answer 2

The plan you join is contractually obligated to pay the percentage it says it will. Once you meet your deductible, the insurance company will pay according to the guidelines it has set up as part of your plan.

For example: you have a $500 per calendar year deductible. Once you meet that deductible, the plan will pay 100% of the contracted rate with the Doctor you see (provided you're seeing an approved, in-network doctor) and you pay only your co-pay if you have one.

Answer 3

I agree with Zarnev, but would also ask that you check to see whether providers have to be "in network". Some will pay 100% after deductible only if the provider is in their network. It's not necessarily a bad thing, but it is something to keep in mind when choosing a provider if your insurance company has this requirement. Also, some require prior authorization before specialist visits or certain procedures will be covered.

Answer 4

Yes, there is a MAJOR hidden exception - they will cover 100% of all COVERED MEDICAL PROCEDURES after the deductible. And SOME things, like cosmetic surgery, are NOT covered. Period.

Another exception - It's likely that your 100% coverage is only for IN NETWORK PROVIDERS. Which are subject to change!!!

Answer 5

I wish with Humana for about a year through my employer and it was the worst insurance company I've ever had.

Answer 6

Read the paper work or call and ask. Most of the time you only pay the deductible make sure you know what it is it's diffenent for Dr.s visit, med's and emergency visits, some medication varies I get some free if it generic and if it not I pay $5. Inform. yourself.

Answer 7

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Answer 8

Read the whole policy. There are usually some exceptions and/or limitations.