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View Full Version : Health Insurance Questions


shadowhawk2020
03-21-12, 03:23 PM
My wife is going to have surgery on May 9th to help with her endometriosis. I have contacted to get a estimate on hospital cost. They typed in my insurance information and surgery codes and the estimate $789. They want us to pay at least half up front. I will also have to pay the anesthesiologist and the Dr doing the surgery.

We have a $600 deductible for my wife then we pay a percentage. How is the total each of the three figured out? I assume the estimate is the $600 deductible plus the percentage for the copay. So then would the doctor and the anesthesiologist only get a copay?

Am I way off base? If so, how does it work?

CRM114
03-21-12, 03:28 PM
Damn, that's harsh. I'm glad I have good insurance.

Th0r S1mpson
03-21-12, 03:46 PM
Ask for more detail and the estimated final cost including anesthesiologist and doctor?

If you're paying a percentage of the doctor and anesthesiologist in addition to this, it could add up.

That sounds more awesome to me than it does to CRM114.

My deductible is several thousand dollars. :)

CRM114
03-21-12, 04:09 PM
My experience has been handing someone an insurance card and never seeing a bill and I was hospitalized twice and my wife had a baby. :shrug:

Several thousand? Aren't you one of the people crying about Obamacare?

orangecrush
03-21-12, 04:43 PM
My experience has been handing someone an insurance card and never seeing a bill and I was hospitalized twice and my wife had a baby. :shrug:

Several thousand? Aren't you one of the people crying about Obamacare?Health insurance without a deductable or co-pay is only available to 1%ers and public employees.

Deftones
03-21-12, 04:49 PM
My wife is going to have surgery on May 9th to help with her endometriosis. I have contacted to get a estimate on hospital cost. They typed in my insurance information and surgery codes and the estimate $789. They want us to pay at least half up front. I will also have to pay the anesthesiologist and the Dr doing the surgery.

We have a $600 deductible for my wife then we pay a percentage. How is the total each of the three figured out? I assume the estimate is the $600 deductible plus the percentage for the copay. So then would the doctor and the anesthesiologist only get a copay?

Am I way off base? If so, how does it work?

out of curiosity, what kind of surgery? laparoscopy? my wife has had 3 of those. none worked much more than a few years. when we started trying for kids, we went to this awesome fertility doctor on the cutting edge of stuff like this. she was prescribed a few medications that significantly helped her issues. pm me if you want some more information.

NORML54601
03-21-12, 04:50 PM
$789 for surgery? Is it being done by some guy in a van?

Sdallnct
03-21-12, 05:17 PM
Your not giving anywhere near enough information.

It sounds like you have a basic group plan, but that is just a guess. You also don't mention if you are using "in network" Dr's and Hospital's (if your plan has a difference for in or out of network) costs.

Personally, I wouldn't trust the Hospital to do what you should be doing. You should ask for what the Hospital told you in writing (should be easy enough) and then you call your health insurance company directly.

I mean if you were in an auto accident and took your car to a body shop and they just said "you owe us $1,000 after all the insurance" would you take that on face value? Probably not.

I'm not a health insurance expert, but something sounds off.

I'm taking it that you have to pay $798 + the Dr's. That just doesn't sound right. Now is $798 is the total including the Dr's, than yea, might be right. What is the grand total for everything (not including any insurance)? And what is your co-insurance? 20%?

Nefarious
03-21-12, 05:24 PM
Your not giving anywhere near enough information.

This.

To give you any additional advice or insight you're going to need to provide information such as:

Copays (PCP; Specialist; Inpatient)
Co-Insurance (In-network & out-of-network)
Max out-of-pocket

You've already provided the deductible of $600.

Assuming you use in-network providers the professional services piece (Anes & doctor doing surgery) won't be near as costly as the facility fees.

Th0r S1mpson
03-21-12, 05:58 PM
Several thousand? Aren't you one of the people crying about Obamacare?

Yes, because my plan and ones like it will soon be phased out, which will drive my monthly rates through the roof. We will be required to have (and pay for) a more comprehensive plan.

Presently we keep enough money in the bank to cover our deductible in case of emergency and chose the coverage that we felt best fit our family. We are all very healthy and spend very little annually on healthcare, so low monthly premiums and high deductible made sense.

That's no longer acceptable in this country. We have to pay whatever the insurance company wants to charge for the plan the government decides we need.

Sdallnct
03-21-12, 07:19 PM
My experience has been handing someone an insurance card and never seeing a bill and I was hospitalized twice and my wife had a baby. :shrug:

Several thousand? Aren't you one of the people crying about Obamacare?

With no frame of reference or details on your plan, that is pretty useless information.

Health insurance without a deductable or co-pay is only available to 1%ers and public employees.

Not at all true. I had an excellent (yes EXCELLENT) HMO when I was in Arizona. Went thru some pretty sever stuff with fantastic service, no deductible (well something like $25) and no co-pay.

When I moved back to Texas, none of the Dr's we used worked with the HMO my company offered. So we went with a Group w/a very high deductible, but my company pays money in HSA for some of that deductible each years.

Even through my employer the premiums were pretty extreme. At the end of the day it is just moving my money around. Pay a higher premium and no deductible or coinsurance or lower premium with deductible and co-insurance.

But I like that it is my choice for what works for me.

shadowhawk2020
03-21-12, 09:09 PM
This.

To give you any additional advice or insight you're going to need to provide information such as:

Copays (PCP; Specialist; Inpatient)
Co-Insurance (In-network & out-of-network)
Max out-of-pocket

You've already provided the deductible of $600.

Assuming you use in-network providers the professional services piece (Anes & doctor doing surgery) won't be near as costly as the facility fees.

All of this will be in network. I double checked.

Copay is 10% after deductible (outpatient surgery Laparoscopy)
Co-Insurance: $4,000 (Family)
Out Of Pocket Max: $4,000 (family)

shadowhawk2020
03-21-12, 09:18 PM
Your not giving anywhere near enough information.

It sounds like you have a basic group plan, but that is just a guess. You also don't mention if you are using "in network" Dr's and Hospital's (if your plan has a difference for in or out of network) costs.

Personally, I wouldn't trust the Hospital to do what you should be doing. You should ask for what the Hospital told you in writing (should be easy enough) and then you call your health insurance company directly.

I mean if you were in an auto accident and took your car to a body shop and they just said "you owe us $1,000 after all the insurance" would you take that on face value? Probably not.

I'm not a health insurance expert, but something sounds off.

I'm taking it that you have to pay $798 + the Dr's. That just doesn't sound right. Now is $798 is the total including the Dr's, than yea, might be right. What is the grand total for everything (not including any insurance)? And what is your co-insurance? 20%?

I am not sure what the grand total of everything is. I have a call into the doctor's billing department and I am not sure who to call for the anesthesiologist. I am going to also contact my insurance company, but the only time I can contact these people is during work and I can only talk on the phone at certain times.

movie diva
03-21-12, 10:59 PM
My wife is going to have surgery on May 9th to help with her endometriosis. I have contacted to get a estimate on hospital cost. They typed in my insurance information and surgery codes and the estimate $789. They want us to pay at least half up front. I will also have to pay the anesthesiologist and the Dr doing the surgery.

We have a $600 deductible for my wife then we pay a percentage. How is the total each of the three figured out? I assume the estimate is the $600 deductible plus the percentage for the copay. So then would the doctor and the anesthesiologist only get a copay?

Am I way off base? If so, how does it work?

Your insurance is not going to kick in until the deductable is paid, so anything you give the Dr or Hospital a percentage will go toward the deductable until it is paid, you need to call the anesthesiologist and the Dr to see if they accept your insurance, if they are out of network or do not use your insurance they do not have to accept you insurance and you will be on the hook for payment.
Do you and your wife have seperate insurance from your employeers, if you do, is she on your policy, if she is you can also use that as a seconday insurance.

shadowhawk2020
03-21-12, 11:04 PM
Your insurance is not going to kick in until the deductable is paid, so anything you give the Dr or Hospital a percentage will go toward the deductable until it is paid, you need to call the anesthesiologist and the Dr to see if they accept your insurance, if they are out of network or do not use your insurance they do not have to accept you insurance and you will be on the hook for payment.
Do you and your wife have seperate insurance from your employeers, if you do, is she on your policy, if she is you can also use that as a seconday insurance.

She is on my policy only. The doctor is covered by our insurance (she is my wife's gyno). The Anesthesiologist is provided by the hospital and if the surgery center is covered I would expect he is as well. All though I will double check.

PopcornTreeCt
03-21-12, 11:08 PM
All of this will be in network. I double checked.

Copay is 10% after deductible (outpatient surgery Laparoscopy)
Co-Insurance: $4,000 (Family)
Out Of Pocket Max: $4,000 (family)

That copay is really coinsurance. A copay is a flat amount versus coinsurance that is a %. Your plan isn't bad (at least compared to mine). I have a $2000 deductible and then have to pay 20% of bill afterwards.

HMO plans, despite being vilified by everyone it seemed, were fantastic. Flat copays for everything. Those were the days.

RunBandoRun
03-21-12, 11:26 PM
I had a hysterectomy in 2008 after suffering from endo for 28 years. Your wife has my sympathy. If she's finished with her childbearing, I would heartily recommend you skip the play surgery and go right to the uterus torn out option. :D

I had an HMO plan at that time that paid all but $300 of the costs (and it was over $13K). That plan is no longer offered by my employer. :( I still have good insurance, but do not know what a surgery would cost me now.

Nefarious
03-21-12, 11:34 PM
That copay is really coinsurance. A copay is a flat amount versus coinsurance that is a %.

Yep. 10% would be co-insurance and that's pretty decent. It may be that you don't have any copays.

If so then you'd just pay 10% of whatever the discounted, or allowable, rate for the physician and anesthesia services. Your physician should be able to tell you what both the billed and allowed charges should be based on your insurance.

Nefarious
03-21-12, 11:50 PM
That's no longer acceptable in this country. We have to pay whatever the insurance company wants to charge for the plan the government decides we need.

That's a pretty myopic view. There are caps on what insurance companies can do via ratios of how much money from premiums must be devoted to actual medical costs. If costs end up lower the insurance company has to issue refunds to policy holders. Over-charging would be pointless and only serve to drive the customer to another carrier.

Contrary to popular belief, the typical profit margin for the major insurance companies is between 3-5%. That's pretty modest, especially when compared to other industries like pharmaceuticals (15%), oil companies (10-11%), and Microsoft or Apple (20%+).

Last, there's a reason it is called insurance. Your family is healthy and that's great. But you never know when a catastrophic medical event might hit. Buying a limited benefit plan with high deductibles seems to make sense...until something bad happens and you either don't have coverage or it is so limited that it doesn't come close to covering the costs.

The government wants to set certain conditions on benefit levels and coverage because those limited plans only end up screwing everyone. The individual doesn't have the coverage and gets hit with bills they can't pay and then the hospital and doctors try to make up the losses by charging more to others. We're all already paying higher costs because their aren't standards. The changes aren't going to make the situation worse, just clearer. So many people buy those limited plans and think they have better insurance than they do or that nothing bad will happen because they are healthy.

PopcornTreeCt
03-22-12, 01:16 AM
Well said, nefarious.

orangecrush
03-22-12, 09:54 AM
Not at all true. I had an excellent (yes EXCELLENT) HMO when I was in Arizona. Went thru some pretty sever stuff with fantastic service, no deductible (well something like $25) and no co-pay.

When I moved back to Texas, none of the Dr's we used worked with the HMO my company offered. So we went with a Group w/a very high deductible, but my company pays money in HSA for some of that deductible each years.

Even through my employer the premiums were pretty extreme. At the end of the day it is just moving my money around. Pay a higher premium and no deductible or coinsurance or lower premium with deductible and co-insurance.

But I like that it is my choice for what works for me.I was mostly joking. Zero deductible, zero co-pay policies have become much rarer though. We have had double digit heath care cost growth for a really long time now and premiums get really expensive for private plans without any kind of deductable, even on a very limited network HMO. Employers and employees tend to choose plans with less expensive premiums (thus more deductables and cost sharing).

CRM114
03-22-12, 09:56 AM
Yes, because my plan and ones like it will soon be phased out, which will drive my monthly rates through the roof. We will be required to have (and pay for) a more comprehensive plan.

Presently we keep enough money in the bank to cover our deductible in case of emergency and chose the coverage that we felt best fit our family. We are all very healthy and spend very little annually on healthcare, so low monthly premiums and high deductible made sense.

That's no longer acceptable in this country. We have to pay whatever the insurance company wants to charge for the plan the government decides we need.

You do know that being healthy today does not preclude something happening "out of the blue" tomorrow? I was young and healthy too when I got viral meningitis and spent a week in a hospital. You get it just a like a cold.

Good luck to you.

CRM114
03-22-12, 09:59 AM
I had an HMO plan at that time that paid all but $300 of the costs (and it was over $13K). That plan is no longer offered by my employer. :( I still have good insurance, but do not know what a surgery would cost me now.

This is the travesty of American healthcare coverage. You pay into an insurance plan your whole life. Hopefully, you never use it. But if you fall ill, why should you have to pay any more than $300? THAT'S WHY YOU PAID FOR INSURANCE! But Americans go along with tales of woe their employers give them.

orangecrush
03-22-12, 10:46 AM
This is the travesty of American healthcare coverage. You pay into an insurance plan your whole life. Hopefully, you never use it. But if you fall ill, why should you have to pay any more than $300? THAT'S WHY YOU PAID FOR INSURANCE! But Americans go along with tales of woe their employers give them.To be fair, many first party insurance coverage’s have deductibles. How many homeowners policies and physical damage auto insurance policies have you seen without a deductable?

RunBandoRun
03-22-12, 10:59 AM
This is the travesty of American healthcare coverage. You pay into an insurance plan your whole life. Hopefully, you never use it. But if you fall ill, why should you have to pay any more than $300? THAT'S WHY YOU PAID FOR INSURANCE! But Americans go along with tales of woe their employers give them.

Well, at the time that I had my surgery, I had been with my employer for just about a year and my portion of the monthly premium for my health insurance coverage was just under $100. For simplicity's sake, I had paid $1,200. I had to pay $100 per day for each of the two and a half days I was actually in the hospital, and the plan covered the rest.

So really, I paid $1,500 for my hysterectomy. Either way, it was still a bargain. :)

CRM114
03-22-12, 11:01 AM
To be fair, many first party insurance coverage’s have deductibles. How many homeowners policies and physical damage auto insurance policies have you seen without a deductable?

The last time I was on an HMO, I don't ever recall having any sort of deductible for hospitalization. But if you are talking about a $15000 4 day stay in a hospital, recouping $500 of that (just because!) is pretty paltry and sad. That being said, it's been over a decade since I was on an HMO type plan so they've probably been chipping away at these benefits just like every other.