Need health insurance, thinking of getting HMO through work?

Question

Hi, I am getting the HMO health plan through my job, and most co-payments are only about 10 dollars, but it shows nothing on how much I pay if for example I need surgery, It does say however that the most I could be charged in one year is $1,500 dollars by the hospitals. Even x-rays have no co-payment though if I need it and vasectomys cost about 100 dollars. My co workee had surgery worth over $5,000, but her insurance paid it all, how do you know what they pay, and when you are asked to pay? I am going in for a ailing left wrist I messed up at work, but no break occured, will I be charged even with insurance(blue cross).

Answer 1

First of all, if you broke your wrist at work, you need to file a worker's comp claim through your work, and they have to take care of your medical expenses.

As for HMOs, they are generally inexpensive. You should be able to get a detailed list of what they will and won't cover from your HR department.

The downside of HMOs is that everything you do must be approved by your personal physician. You don't have the freedom to see any specialist you want to, you have to get authorized by your primary physician first. In my experience, I have not had to pay anything for x-rays or other diagnostic tests. But if you have any major health problems, especially rare diseases that most doctors aren't experienced with, you should opt for a PPO.

Answer 2

First of all, if you messed up your wrist at work, you file an accident report at the job and THEY send you to the doctor and THEY pay for it. That it not your responsibility.

Second, sounds like you don't have the HMO insurance yet, so wait until you have confirmation from the insurance company that you are insured before you go to the doctor for anything else. Otherwise, you may not be covered and will have to pay the whole bill.

Lastly, call the HMO benefits coordinator and ask what is covered. They should have a complete brochure of everything that is and is not covered.

Answer 3

Typically, HMOs are worth it. They are more tightly managed than PPO plans. You are restricted to your primary care physician and doctors within your medical group. This is not a problem in larger areas, but if you're in a more rural area with less access to a variety of specialists, it can become more problematic. To me, it sounds like a good plan. I've been with an HMO for the past 5+ years, and have no complaints!

Answer 4

I work for an health insurance company.

Ask your doctor for the proceedure code of the operation and the diagnosis code for your injuries.

Call up the telephone number for customer service. They'll give you your out-of-pocket deductibles/copays and your max limits (sounds like $1500. Make sure you use your HMO hospital or Dr or it may not be covered in full.

Answer 5

There isn't one answer for this... If you've signed up through work you'll probably get a big packet soon with the answers to your questions. It should detail what procedures they cover-- but HMOs also work in case by case matters for surgeries, most likely you wil be covered for a percentage of any expensive procedure.

Answer 6

That is a great insurance company! i used to have it til my company switched over to cigna.

no , they will pay , just show your insurance card when you go in, they'll make a copy of it.
then you will get something called an "EOB", (explaination of benefits) Do not pay that. it's is only telling what your insurance will pay. it is not a bill.

you will later, get the bill from the hospital from where you get your x-ray. After, the insuance pays.

going to the dr. you pay your 10.00 co-pay up front before you see the dr.

Answer 7

All plans are different, you should ask whoever is in charge of the plan at your job or call the customer service number on your insurance card. No onw who reads this will be able to give you the answer you need.

Answer 8

Co-pay at time of visit generally, but you can just ask your superior what is a co-pay, what is not and how much. Go to FAQ of the insurance companys website. Happy health

Answer 9

i'm guessing it would desire to be stressful to locate a private scientific wellbeing insurance business enterprise which will furnish you insurance with useful top rate costs in case you have a terminal ailment. i don't be attentive to the place you reside yet according to danger you could desire to objective utilising for state scientific suggestions which, in case you qualify based on your income/components/age/wellbeing situation, might help pay for scientific expenditures till you detect some thing else.

Answer 10

There should be a phone number on the insurance card and if you call they can help with that.