Fatboyslick

Hi

My wife has a range of Medical Insurance types from her work, some are fee for service, some Managed Care, some a combination.

What we're tripping ourselves up on is the Deductible.

I've read that in order to gain the benefit of the medical insurance e.g. paying x% of the treatment/appointment we have to pay the WHOLE deductible.

When the deductible is $4,000 I'm finding it difficult to accept my understanding of it is correct - surely paying $4k in order for me to get some new Asthma inhalers is a little far fetched. Especially when we'd be paying $300 a month for the insurance premium.

Can anyone put me right me please (in my understanding, not curing the asthma - although that'd be welcome)

If it helps I can post some of the policies we've been offered

Thanks in advance

SanDiegogirl

The way deductibles are "usually" paid is that for some services (not all services/treatments are eligible for deductibles) a portion of the service/treatment is put towards your deductible up to the point where you have paid all the deductible and then the insurance company picks up the whole cost of the service/treatment, less your % portion of it.

So, say you have just started using your policy and your deductible is 1,000 bucks.

Your first service/treatment comes to 300 bucks. 100 goes towards your deductible and you pay 200 bucks. You next service treatment is 250 bucks. 75 bucks goes towards your deductible and you pick up the remaining 175 bucks. This goes on until the company have their 1000 deductible. After that its company pays bill less your percentage.

You've probably got a total out of pocket cost - which is the total you need to pay before the company picks up all of the bill.

This is how my policies have always worked.

nun

On many policies you will have to pay the whole deductible before the insurance starts. Then you will have to pay part of the cost until you reach your out of pocket annual max and the insurance covers the rest.

Medications are often treated separately. Watch out for doctors prescribing specific drugs when generics might work just as well.

When working out the cost per year you should add the annual premiums to your out of pocket max and make sure you can afford that amount. Welcome to the wonderful world of American healthcare.....just pray that it can be stopped from taking over the UK.

petitefrancaise

You need to look at the package as a whole.

A deductible is the maximum amount you can pay in a year.

The higher the deductible usually the lower the premium - like car insurance.

My insurance has an $8k deductible for the whole family of 5

What counts towards my deductible is the co-insurance I pay of 10%. So, I go to hospital for a morning of surgery and the total bill paid by my insurance is $50k. My part of that is $5k and that counts towards the deductible.

My co-pays do not count towards the deductible and neither does the prescription cost or optician stuff.

For us, this works and means I don't ever worry about going to the doctor.

Pulaski has a high deductible and he pays all the medical costs up to that point but his insurance premium is lower and he and his wife have maxed out their flex/health savings accounts.

SanDiegogirl

This is not correct for some policies. Some have the deductible but a total out of pocket cost which could be higher, based on the fact that after the deductible is maxed out there are still co-pays and co-insurance to pay.

In one policy I had the deductible was 1K but the total out of pockets costs for the year were 2K.

petitefrancaise

I am never, ever going to fully get this system........

Fatboyslick

I guess it'd be good to see how much treatments are to help put it into context. I have no idea how much the medical costs are if, for example, I pull a hamstring

Canveydave

Were I to pull a hamstring I would hop into CVS, get a tubigrip bandage and try to suck it up!

That's what's wrong with the system for me, the need to try and self medicate to avoid a $250 trip to sign in at an emergency room!

Noorah101

My insurance through work utilizes a co-pay system. To see my regular doctor, I pay $20 per office visit. Sometimes it takes 2 weeks or more for an appointment. What I've been doing is going to my local Urgent Care, which is 1 block from my house, they see me immediately, and is $25 per visit. Works out well.

Rene

Pulaski

What she said.

What some people are slow to grasp is that if you have a policy that costs $300/mth with a $2,000 deductible but only have $1,500 medical expenses, you would have been better off paying $150/mth with a $4,000 deductible. The sneaky bit is realising that if your medical expenses are $3,500 you are still better off with the $150/mth policy, because although you have to pay an extra $1,500 out of pocket, you have saved $1,800 in premiums. ..... On the figures I used, the maximum you would be worse off is $200, if your medical expenses exceed $3,800, and once you reach $4,000 your insurance kicks in. In short, a lot of people are paying insurance premiums for coverage they don't need.

SanDiegogirl

This is one of the biggest bugbears about the US system.

The 'experts" tell you that procedures are like anything else - different suppliers charge different rates, so shop around.

However, just try and get a cost out of a hospital or clinic for any procedure from having an X ray to having a hysterectomy and no-one will be able to go to a list and give you a cost!!!!

The damn primary physician usually can't tell you now much his group charges for a consultation!

Hence the huge costs for medical treatment - they charge what they like!!

doconthemove

You should be able to get quotes for medical imaging. These are standard things and I have seen cash price lists for such. However when you talk about hysterectomy or any surgery that totally different ball game how can you expect a price when so many different variables e.g the type of anesthetic you will need, how many days post-op recovery etc It is going to be hard to estimate a cost for surgery since if you have complications the bill is going to go up accordingly. Very little that can go wrong with imaging!

md95065

Round here I very much doubt that it would be possible to run up a $250 bill for a simple trip to the emergency room. In my experience you are looking at an absolute minimum of about $450 the moment that you walk in the door ... :-(

md95065

One of the most common "complications" of surgery in the U.S. is discovering when the bill arrives that while the surgeon, anaesthetist, and hospital were all "in network" for your insurance, the surgeon's physician assistant (who spent all of 5 minutes explaining where and when the surgery was scheduled to take place) and one of the nurses who held the door open were "out of network" ...

Fatboyslick

My God this is a minefield isn't it! I don't think the majority of the UK understands how bad it'd be if this was to replace the NHS


If anyone could spend a few minutes to help me further please....Attached is one of the polices we've been offered at $240 a month to cover two of us.

There's three attachments what detail some of the benefits. The grey box is where I've blurred out the name of our company.

Can anyone explain to me then how this would work please?

Thank you so much for your help