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Could I have picked the wrong health insurance?

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Why?? posted 6/29/2013 18:23 PM

Mildy freaking right now. I started a new job at an institution at the end of last year. I thought I was supposed to have really good benefits. I picked a CareFirst Blue Cross plan that I thought was good. So, I have my 1st appt. at the dermatologist and didn't have to pay a copay. I then get an explanation of benefits that says the insurance is paying zero and I owe $190.00! Next I get a bill from the Dr.'s office. It also said something on the EOB about a $2000.00 deductible not being met. I hope this is some awful mistake. At my last company I never had to pay a cent besides the employee contribution from my paycheck nothing at any appt. What have I done?

[This message edited by Why?? at 6:24 PM, June 29th (Saturday)]

gonecrazy posted 6/29/2013 18:55 PM

I work for the state of Ohio and I wish I had a 2000 deduct. Ours is 5000 per person per year, plus I pay 400 a month out of my pocket

TrustNoOne posted 6/29/2013 19:12 PM

I pay $90/month out of my paycheck for my son and I, and I have to reach at $2500 deductible.

Programs like these will become the norm. Sky-rocketing healthcare costs are creating an unsustainable model.

yewtree posted 6/29/2013 19:20 PM

You may have gone to a specialist who is not part of the bc bs network for your group. Call the insurance company and ask for an explanation.

[This message edited by yewtree at 7:21 PM, June 29th (Saturday)]

Amazonia posted 6/29/2013 19:33 PM

I have CareFirst. My deductible is a thousand dollars. There was one other PPO option that had a two thousand dollar deductible, or an HMO option.

Go back and check your plan. It's very possible.

Personally, I meet the deductible really quickly through IC and the chiropractor, and then just pack in the doctors visits

Eranda posted 6/30/2013 01:44 AM

Nearly every health insurance plan includes a deductible of some amount. Currently mine is $2500.

However, my company has it set up so that employees pay the first $1000 and then the company pays the second $1500. This allows them to reduce employee costs while getting a lower premium due to a higher deductible.

Perhaps your previous employer was covering the deductible amount for you...? Did you read the plan information before you signed up for the plan? They all spell out what the costs are- copays, co-insurance (your portion of any and all costs incurred, usually 90/10, 80/20 etc. meaing the insurance pays 80% and you pay 20% of any bills) and deductibles. It's usually all there in the information you get before you sign up.

I've never EVER heard of a health insurance plan that covered everything 100% without the member paying any copays, co-insurance or deductible. The premiums on a plan like that would be astonomical to say the least.

Consider yourself lucky if your deductible is only $2000. Most people's is WAY higher than that.

Why?? posted 6/30/2013 09:22 AM

My last company gave us a debit card which covered any co-pays, etc. so I never paid more than the employee portion out of my paycheck.

Did a little checking on my company's web site. I think my deductible is $500 and it says out of pocket expenses $2000. What is the difference? This was an annual skin check so I would hope this would go towards the $500. They did have to remove a mole so that was considered surgery so is this the out of pocket stuff?

I really had a better plan at the old job...oh, well...

Will call insurance company on Monday to figure this out.

[This message edited by Why?? at 9:23 AM, June 30th (Sunday)]

lynnm1947 posted 6/30/2013 09:24 AM

I've never EVER heard of a health insurance plan that covered everything 100%

I have. Americans call it socialized (or sometimes "commie") medicine. We in Canada call it normal. (It doesn't pay for chiropractic any more and the dentist is extra, but an expensive operation won't send us into bankruptcy if we don't have added insurance.)

[This message edited by lynnm1947 at 9:27 AM, June 30th (Sunday)]

Dark Inertia posted 6/30/2013 09:30 AM

Did you choose PPO or HDHP? I am in Ohio, I have HDHP and I have to meet $3000. My insurance is with United Healthcare, which I have heard is inferior to Blue Cross. $2000 deductible sounds about the norm for a PPO.

My last company gave us a debit card which covered any co-pays, etc. so I never paid more than the employee portion out of my paycheck.

Yeah, this sounds like you had an FSA card. Your company did not pay for this. This would also come out of your check. If you signed up for the PPO then you have the option of getting another FSA card. You do have to bear in mind that the money is gone and lost if not used up within a year AND it does come out of your check, though it is in increments. But all PPOs have the option of getting an FSA card. HDHP have HSA.

Deductibles are not a tab that companies will generally pick up for their employees.

[This message edited by Dark Inertia at 9:51 AM, June 30th (Sunday)]

Amazonia posted 6/30/2013 13:54 PM

Do you have a CareFirst online account? I have one that I used my member number to set up, and I can track my deductible that way. Usually you hit your deductible, then pay copay, up to the amount that your plan has for max out of pocket expenses. For my plan, anything in network is $1000 deductible, then 10% copay up to $5000. If I were to spend $5000 on copays in a year, I wouldn't have to pay anything else.

Why?? posted 6/30/2013 14:03 PM

No, it was not an FSA account. My last employer put about $2000 on debit cards for us to use. I only paid about $40 a paycheck for my portion of the insurance plan.

Ama - Haven't set this up yet but I believe I should be able to. I have had 3 IC visits this year for $125 each and another appt. soon so that makes $500. Just unsure what the $2000 out of pocket means vs. $500 deductible.

InnerLight posted 6/30/2013 15:27 PM

I pay $408/mo and the deductible is 7000. My colleague on the same plan is 5 years older so she pays $500/mo. Neither of us has used it these past 4 years, but it goesmup $10-$60 every year. it's not healthcare, it's just there for emergencies. This is not unusual for many many many Americans. It is shameful.

rainagain posted 6/30/2013 23:14 PM

I paid $1160 each month towards my family health plan while my employer paid the rest. There was a $2000. deductible. My employer was a small not for profit. If they had not offered ins. I could have purchased the equivalent through my state for half the cost with no deductible. But because my employer offered it I am not eligible. I am also required by court order to carry my X. Insurance is expensive - here it sounds even more so.

rainagain posted 6/30/2013 23:18 PM

In 1995 I worked for a family owned newspaper that paid 100% of our family plan Blue Cross Blue Shield.
Those were the days.

Whalers11 posted 7/1/2013 06:22 AM

The $2,000 out of pocket vs. $500 deductible means once you have to pay 100% for certain types of care, until you have paid $500 (your deductible). Then the cost is usually split 80/20 or 90/10 between you and your insurance. Your portion of those splits will not exceed $2,000 a year - once you pay $2,000, the insurance will pick up the rest...

Want2help posted 7/1/2013 11:15 AM

This is really, REALLY scaring me.

At my last job (I had worked there since I was 18, and then I was laid off in 2008, now I'm a returning college student) I didn't pay anything for health insurance, and all I paid was a $20 co-payment for doctor's visits, IC visits, etc.

If I went to urgent care, they only covered 80%.

Is this NOT the norm anymore? Will I ever see this kind of coverage again?

tushnurse posted 7/1/2013 12:09 PM

OK if you can think of a way to mix up the burden of cost for insurance there is a plan out there for it.

Your deductible is the amount for which you are responsible out of pocket, and usually can range from nothing to thousands of dollars. Usually the higher the deductible, the less that is covered until said deductible is met. This is basically what is know as a Catastrophic plan, and many employers of smaller businesses will have this, it's really the only thing that many can afford.

Your Co-pay is the amount that you are expected to pay when you see a Dr, Specialist, Urgent Care, ER etc. This is like a promise that you are responsible for some, and the insurance company is responsible for some of the costs. Again in a low deductible/"good" plan this is reasonable. In a High deductible plan there may not even be a copay. Because it's all on you until you hit a high dollar mark.

Now the last little piece is what is called co-insurance, this is the part that you the carrier is responsible for after the bill is submitted and insurance has paid. Many many many plans will have a 70-30, 80-20, or 90-10 plan, where they pay 70% and you are responsible for 30% up to X number of dollars. This is your Total out of pocket, and is different than your deductible.

I know very confusing right. At the end of the day though with it being a new plan for you I would guess that the insurer denied the claim until you contact them and confirm that you have no other insurance, and have proof of continuous coverage. This is a nice little trick that all the major players use. It delays payment, and if the carrier doesn't follow through the bill is on them.

Call the insurance provider, call the Dr office and ask to speak to the biller, and have her define why the insurance company paid $0.00. They may have denied the claim because of something simple like a wrong dob entered.

I know this is a lengthy answer, and I have said more than once if anyone else ran their business the way insurance companies are allowed to they would be in jail.

Eranda posted 7/1/2013 19:32 PM

Your EOB should tell you why the claim was denied. If you haven't met your deductible yet, the provider will apply the amount to the deductible until it's satisfied and the provider will then bill you for the amount. Once the deductible is satisfied, claims will be submitted to the insurance company. They will pay their portion (70%, 80% or 90% usually) and the provider will bill you for the remaining portion that is your responsibility under the plan (30%/20%/10%).

Yes, your out of pocket maximum means the most you can pay in deductible and co-insurance (your percentage). After that the insurance pays 100%, aside from co-pays.

Yes, this is the way ALL insurance is now. No insurance that I know of picks up 100% of any costs. The patient is always responsible for a deductible and co-pays, as well as co-insurance.

What you had previously was likely the same kind of plan, but the company gave you the $$ on the pre-paid card to cover that amount. There was still a deductible on the plan, your employer just paid it.

Consider yourself lucky that you had that deal for as long as you did, it's VERY unusual.

You will have to pay your bills out of pocket until you hit the deductible, then the insurance will pay a percentage of any costs over that, and you will pay a percentage. That's how it works.

tushnurse posted 7/2/2013 07:55 AM

Why - I hope I didn't scare you off.

Please know that if it truly is a large deductible plan and you were unaware of it to call the providers of your care, and let them know the situation, most are more than willing to work with you on a payment plan. It's much easier to do that then send you to collections, and it shows an effort on your part. The people that hide from the bills, and never answer the calls always were the first to go to collections, when I managed an office.

Why?? posted 7/3/2013 20:22 PM

Hi guys,
Thanks so much for all the feedback. No you didn't scare me off I can't post from work and my home laptop is on it's last legs.

So I spoke with my insurance co. and I do have to pay the $190 derm. bill and have the $500 deductible. Guess I was really lucky to never have had to pay for insurance other than the employee portion out of my paycheck. I have 3 visits from IC this year for $125 each so I'll submit those and have another visit next week so that will put me over the $500.

Guess, most of us are dealing with these higher insurance costs it seems

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