Health Insurance

FCXoptions · Mar 12, 2013

Random personal health insurance question here

So is it normal for insurance to not pay a $ of any charge until your deductible is met? I have insurance through my work on my own for the first time now, it is just my son and I on it. My wife is covered on her own. Well we had to take him to the emergency room earlier this month, and the bill just showed up on my insurance website and it says they paid $0 of it, and that I had to pay the entire balance. I did get the healthcare discount that they get of course, but still they aren't paying anything. And we have gotten several other doctor bills that they haven't paid a dime of. I am just a little confused on this, as I thought they paid a percentage as did I. Not me pay everything until my deductible is met.

PHOENIX TRADING · Mar 12, 2013

Quote from FCXoptions:

Random personal health insurance question here

So is it normal for insurance to not pay a $ of any charge until your deductible is met?

Yep, what do you think the deductible means?

Scataphagos · Mar 12, 2013

Quote from FCXoptions:

Random personal health insurance question here

So is it normal for insurance to not pay a $ of any charge until your deductible is met? I have insurance through my work on my own for the first time now, it is just my son and I on it. My wife is covered on her own. Well we had to take him to the emergency room earlier this month, and the bill just showed up on my insurance website and it says they paid $0 of it, and that I had to pay the entire balance. I did get the healthcare discount that they get of course, but still they aren't paying anything. And we have gotten several other doctor bills that they haven't paid a dime of. I am just a little confused on this, as I thought they paid a percentage as did I. Not me pay everything until my deductible is met.

Yes, you pay 100% of the bill until the deductible per person/family is met. Then insurance pays a percentage above that until your "out of pocket maximum" is reached.

Example... some years ago I had a ruptured appendix and had to go to the ER. I paid the $500 ER charge and with that met my deductible... then paid 20% of the bill up to my "maximum out of pocket charge" of $5,000. Insurance paid the "80% up to my $5,000 out-of-pocket"... then insurance paid 100% above that.

I paid $5,500... insurance paid the balance of the bill. (Other than the "negotiated rate" given by the hospital to the insurance company, the actual bill was just a bit shy of $100,000*.) Generally how many plans work.

* For an appendix. Can you imagine what a heart procedure would cost??

FCXoptions · Mar 12, 2013

Ok, I see. I was under the impression on health insurance that they paid a portion and I paid a portion until that deductible was met. I didn't realize every dollar was out of pocket until that point. I remember seeing 80/20 but I am assuming that is after my deductible is met.

Scataphagos · Mar 12, 2013

Quote from FCXoptions:

Ok, I see. I was under the impression on health insurance that they paid a portion and I paid a portion until that deductible was met. I didn't realize every dollar was out of pocket until that point. I remember seeing 80/20 but I am assuming that is after my deductible is met.

Yes... "after deductible is met"..

PHOENIX TRADING · Mar 12, 2013

Quote from FCXoptions:

Ok, I see. I was under the impression on health insurance that they paid a portion and I paid a portion until that deductible was met. I didn't realize every dollar was out of pocket until that point. I remember seeing 80/20 but I am assuming that is after my deductible is met.

yes and as previously mentioned there usually is both a maximum out of pocket you have to pay even at 80/20.

And be aware that there is a lifetime benefit amount usually a million.
usually isn't a problem unless multiple cancer etc.

Wallet · Mar 12, 2013

Quote from FCXoptions:

Random personal health insurance question here

So is it normal for insurance to not pay a $ of any charge until your deductible is met? I have insurance through my work on my own for the first time now, it is just my son and I on it. My wife is covered on her own. Well we had to take him to the emergency room earlier this month, and the bill just showed up on my insurance website and it says they paid $0 of it, and that I had to pay the entire balance. I did get the healthcare discount that they get of course, but still they aren't paying anything. And we have gotten several other doctor bills that they haven't paid a dime of. I am just a little confused on this, as I thought they paid a percentage as did I. Not me pay everything until my deductible is met.

If you have the ability to pay the balance in full you can negotiate even more over the final balance. Most hospitals and doctors' offices will deduct an extra percentage or set amount to receive a large payment instead of installments for the balance.

As long as hospitals and doctors continue to overcharge the insurance companies serious heath care reform will never take place.

FCXoptions · Mar 12, 2013

Quote from Wallet:

If you have the ability to pay the balance in full you can negotiate even more over the final balance. Most hospitals and doctors' offices will deduct an extra percentage or set amount to receive a large payment instead of installments for the balance.

As long as hospitals and doctors continue to overcharge the insurance companies serious heath care reform will never take place.

Yea, that might be a good idea. The bill wasn't really bad or anything I guess. I had a health savings account that it used up which paid about half of it and then I have to pay the rest out of pocket I believe. I haven't gotten the bill yet though, it was just listed on Aetna's site. I will try calling the hospital though once it comes in and see if we can get a little discount for a lump sum.

FCXoptions · Mar 12, 2013

Quote from PHOENIX TRADING:

yes and as previously mentioned there usually is both a maximum out of pocket you have to pay even at 80/20.

And be aware that there is a lifetime benefit amount usually a million.
usually isn't a problem unless multiple cancer etc.

Yea, hopefully we won't get anywhere near that limit anytime soon!

AK Forty Seven · Mar 12, 2013

Quote from FCXoptions:

Random personal health insurance question here

So is it normal for insurance to not pay a $ of any charge until your deductible is met? I have insurance through my work on my own for the first time now, it is just my son and I on it. My wife is covered on her own. Well we had to take him to the emergency room earlier this month, and the bill just showed up on my insurance website and it says they paid $0 of it, and that I had to pay the entire balance. I did get the healthcare discount that they get of course, but still they aren't paying anything. And we have gotten several other doctor bills that they haven't paid a dime of. I am just a little confused on this, as I thought they paid a percentage as did I. Not me pay everything until my deductible is met.

My insurance offers once a year free physical and flu shot but other then that I pay until I meet my deductible