Deductable Question

[mwest1 4]

i am new to this, so whats does it mean when they say u have to meet ur deductable from ur insurance is that like paying off a bill or something because i tried to pay my full deductable but i didnt have an account therefore i couldnt pay it and im only at 475 i need to reach 3000. but i do have a hospital bill for 700 so if i pay that will that go toward my deductable..

[Amanda611 0]

Deductibles are very confusing to explain so I hope that I don't confuse you ever more Your health insurance deductible is something that must be paid by YOU before your insurance will pay anything toward your medical claims. There really isn't anyway to pay off your full deductible without accumulating claims. Each time you go to the doctor, hospital, etc, and you use your insurance you are essentially creating a medical claim that the doctor or hospital bills to your insurance company. From there, your insurance company will determine how much they will or will not pay based on your benefits. So for example, you have a 3000.00 deductible and you go to the hospital and the hospital bills your insurance company 1000.00 for that visit. Your insurance company processes the claim and sees that you have not met anything toward your 3000.00 deductible so they will not pay. They will then notify the hospital who will in turn bill you for the 1000.00. At the same time, your insurance company will deduct the 1000.00 that you are paying the hospital off of your deductible so you would only have 2000.00 left toward your deductible to meet.

The confusing thing to most people is that you are NOT paying your health insurance company this deductible, it is an accumulation over time that you are paying to various doctors. So to answer your question, your 700.00 hospital bill should go toward your deductible reducing it down from 2525.00 to 1875.00. So would have 1875.00 left to meet before your insurance would start paying any portion of your claims. If you are still confused, it is best to call your insurance company and have them explain this to you and also, you can familiarize yourself with your benefits because sometime even after your deductible is met you may still be responsible for a portion of the claim. Good Luck and if you still have any questions, let me know

[xavier 153]

Basically it just means for any healthcare you receive, the first 3K is on you...after that they pay.

[Lollicatt 36]

Wow I did not know this.. Thanks for asking... Do copays. Go towards the deductible?

[Lollicatt 36]

Wow I did not know this.. Thanks for asking... Do copays. Go towards the deductible?

[Lollicatt 36]

Wait so if my oop was 1300, it's really 4300 because I have a 3000 deductible?

[Amanda611 0]

Wow I did not know this.. Thanks for asking... Do copays. Go towards the deductible?

It depends on how your policy is set-up. Some policies stipulate that copays go toward deductibles while other policies exclude copays. You will want to check with your health insurance.

[Amanda611 0]

Wait so if my oop was 1300, it's really 4300 because I have a 3000 deductible?

This is pretty much along the same lines as your copay question. It depends solely upon how the policy is set-up. Some policies are set-up to allow any amount paid toward the deductible to apply to the out of pocket max while others have a seperate deductible and a seperate out of pocket. For example, on my insurance I have a 1000 deductible and a 2000 oop but my deductible applies toward my oop so in reality I would only be paying a total of 2000 versus 3000 if they were figured seperately.

It does appear that since your oop is lower in comparison to your deductible that they are seperate and that yes, your total amount that you could be responsible for paying would be 4300.00.

[NWgirl 574]

Some insurance plans also pay as you go and slowly add to the deductible. Before my switch to Anthem BCBS, I was with Regence BCBS, and that particular plan allowed me to go to the Dr and pay copays. I would sometimes receive a bill, but insurance immediately started paying out instead of requiring the whole deductible be paid first.

For my particular insurance (Anthem BCBS), my family deductible is $2500 and my max out of pocket is $3000. There are four people total on my plan, and so any medical care received before insurance started to pay out went to the deductible. At this point in time, insurance is now paying some on medical bills, so anything I pay is going towards my out of pocket max.

So, for example, the hospital I am getting my surgery at usually charges between 18k-21k for the surgery. My insurance plan requires the deductible + 20% for payment towards the surgery. I am currently at $1750 in out of pocket costs and my MAX out of pocket for the year is $3k. If I did not have a cap on spending, I would be looking at another $4k payment to receive my surgery, but because of the out-of-pocket max, I should only owe $1250.

Hopefully this was easier to understand. I would call the insurance company for clarification if you are confused, as there are multiple plan types and different ways they figure deductibles.

[Grandcherokee 6]

My Blue Care Network ( Mich) said it was 100 % covered..Later I found out that the $800.00 classes and the $150.00 liquid diet that was mandotory out of pocket was not a reimbursement qualified fee! I summited it but it got declined. I was hopeing to use that for some new clothes ! So far everything else has been covered.