TonkaToy

What do you mean by you "used receipts"?

rew1000

They don't know.

What they'll do is ask "What's your copay?" or even not ask at all. If you know what portion you should be paying them, you can pay them. If not, it doesn't matter.

Then they'll send a bill to your insurance company (often two bills, one from the doctor, one from the facility).

Then your insurance decides what it will pay, what you should pay, and what no-ones going to pay and the doctor's just going to have to lump it.

Typically the insurance company will send you a piece of paper explaining their decision (if a series of four character codes is an explanation).

After all this, if there's still money for you to pay, your doctor will send you a bill saying "you owe us x". If you paid your copay at the time, this bit won't happen.

I'll second the other suggestions to sign up for the health insurance offered (but not the FSA/HSA - they are just a tax dodge that is only worth it if you *know* exactly what your out of pocket health expenses will be) and learn as you go along. Confusing health insurance is better than no health insurance!

penguinsix

rew is right--the FSA/HSA are only really worth it if you can figure out pretty much exactly how much 'out of pocket' you are going to pay in a given year. Some things are easy, like if you wear and buy glasses/contacts each year you can set aside money for that, and say you have an infant that has a set number of doctor visits next year, you can add up those copays and set it aside (the FSA is taken out of your paycheck and held by a third party until you send the receipts, at which time they send you a check. You don't pay taxes on the money you set aside, but if you set aside too much you can be kind of out of luck).

rew1000

[just noticed penguinsix's reply - this kind of duplicates but spells it out...]

Here's an explanation of FSA/HSAs as I understand it.

You ask your employer to take some of your pay, before tax, and put it in account.

You can spend money from that account on anything permitted by the IRS - typically health-related expenses (copays etc, things from the pharmacy, dental bills etc.), child care.

Either you're given a debit card to spend from the account, or you file claims to get the money by sending in receipts.

Places like Target now print receipts that highlight and total the items that are eligible.

At the end of the year, anything you haven't spent is lost (and I believe the employer gets to keep, which would explain why they push these schemes).

So the potential up-side is that money that you spend on health-related items isn't taxed. The potential down-side is that you forfeit the money that you didn't get round to spending.

helwardman

Just take the scheme as offered by your employer. It will (probably) be cheaper than any you could find on your own, plus you'll (probably) be paying for it out of pre-tax earnings.

tamms_1965

Most companies have an HR person that goes over this in "plain English" with you. If not, I would ask.

tamms_1965

I've been doing this for years and I swear by them. They will also cover over-the-counter meds such as aspirin and things like contact solution and tampons. If I ever feel that I may not use up what I have put in the account, I will order more contact lenses. You could also stock up on otc meds too. I have never had a problem using it up though.

My company allows you to fax copies of your receipts with a cover sheet. I get my check 5-10 days later. I try to wait until I have several hundred dollars worth of receipts before I send it in though....it's a nice chunk to put into a vacation account.

Also, you can get reimbursements even if the money is not in the account yet (good for childcare) because they know it will be there eventually.

MsElui

think of co-pay as a policy excess. its not exactly the same but it is similar - ie its the amount you have to pay yourself. It is cumulative over a year (jan to dec) and can go over more than one claim. Certain things are covered by the insurance at 100% (say kids immunisations, dental checkups) so you dont hit the deductible at all (think cracked windshield on a car - usually fixed for free on the car insurance and not subject to any of your normal excess). The amount that is covered by the insurance may depend on whether your doctor is in or out of network (think using a insurance registered repairer for your car brakedown). when i just had a baby - using an in network doc i was covered for 80% - with an out of network midwife i was covered for 60%.

co-pay is like a fee to see the doctor. For me is a flat rate $10. no matter what i want to see them for - i have to pay the $10. its like a disencentive to make frivolous visits. the actual doctors bill for whatever i needed to see them for is paid depending on what my insurance covers.

TonkaToy

Yes, but if I sign up to something that I don't understand and subsequently discover something that I don't like/want/isn't covered (I won't get to know the full extent of what is and what isn't covered until after I get my policy documents!!) and then can't get out of it or are faced with paying a huge bill etc, I am forced to continue to pay hefty premiums for the rest of the policy term and the insurance company/employer can always turn round and say, well you signed up to the scheme didn't you?

Also, I am a diabetic and currently I get all my medicine free through a charity.
The only reasons I am considering health insurance that is being offered is that the charity doesn't offer other health services, like dental attention, etc., and also because my wife has a couple of health needs that the charity do not have any expertise in.
(I think these services are not covered under the policy but we are not 100% sure)

My medicines are currently running to about $900 per month.

fatbrit

Have you tried Canadian on-line pharmacies? They can be cheaper than your co-pay.

tamms_1965

You are crazy if you do not take the insurance your employer offers. Some people would give their good arm for coverage they could afford. Medical bills could bankrupt you and make your life miserable. It has done to many, many people hear.

I would think that a charity would frown upon someone accepting meds from them if that person had an opportunity to get reasonable health insurance. There are many people out there who do not even get the choice. In my mind, charity was for people who have exhausted all other avenues and are truly needy and it sounds like you have not.

You should find out about your plan's prescription card if one is part of the insurance...mine is. I pay $20 for non-generic and $10 for generic. Kroger and Wal-mart sell most common generic drugs for only $4 to anyone with or w/o insurance.

tamms_1965

My previous neighbor got all of hers this way.

meauxna

I was wondering about the immigration implications, depending on the visa type.

snowbunny

The OP is a heavy user. (Nothing wrong with that, just the facts.)

Given that I'd check first if there are per-year or lifetime caps.

Then I'd give priority to plans that ONLY require copays and not a percentage of each expense.

Then I'd see whether my current doctors are "providers" in the plan - because seeing an outside provider is really expensive. Nearly all health insurers post their provider lists online, or one can ASK the doctor whether they accept XYZ insurance. Be prepared though to hear that they may only participate in one subset - "we are in the Purple Network, but not on the Green Network."

If you are a diabetic then health insurance should be a very heavy concern, since diabetes can lead to complications even if well controlled. Keep coverage.

Meauxna is right - what kind of visa you're here on is important. If you married in, then pursue citizenship as soon as you're eligible.

TonkaToy

There are so many options, choices, exclusions, things that say "provided such and such" for other things and on and on. I don't even know what what you refer to as lifetime caps are.

There are none that are only co-pay.

I have never been seen by a doctor in the US, other than those whop are working at the charity and who only treat my diabetes. I suppose I would have to ask around for recommendations of doctors as I don't know any.
I would intend to go in network (that bit at least I understand!)