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Anyone ever hear of 'Co-insurance' pay for a Dr visit?

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Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Old 11-25-14, 02:42 PM
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Anyone ever hear of 'Co-insurance' pay for a Dr visit?

...because I have not. My job requires me to get a TB test every 3 yrs. Paid my $20 co-pay at the office. A month later, i get a bill from the Dr for $10.33. Just got off the phone with them, she claims its a co-insurance pay. Is this a new thing??
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Old 11-25-14, 02:46 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

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Old 11-25-14, 02:48 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

This has been around for a looooong time.

as a way to control insurance costs, insured are required to pay a % of the visit in the form of a co-pay - and then the insurance will pay the rest of the amount for the service rendered.
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Old 11-25-14, 03:05 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by CPA-ESQ. View Post
This has been around for a looooong time.

as a way to control insurance costs, insured are required to pay a % of the visit in the form of a co-pay - and then the insurance will pay the rest of the amount for the service rendered.
Coinsurance is not copay.
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Old 11-25-14, 03:20 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

yeah
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Old 11-25-14, 03:46 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Insurance companies pay what they determine is "reasonable and customary". They include medicare payments in the calculation to reduce the amount. You're on the hook for anything above that.
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Old 11-25-14, 03:48 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by Nick Danger View Post
Insurance companies pay what they determine is "reasonable and customary". They include medicare payments in the calculation to reduce the amount. You're on the hook for anything above that.
not necessarily. many insurance companies have contracts with providers that prevent them from doing this.

OP, you should be talking to your HR dept and if they are worthless (likely) then the insurance company.
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Old 11-25-14, 04:36 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by JZ1276 View Post
...because I have not. My job requires me to get a TB test every 3 yrs. Paid my $20 co-pay at the office. A month later, i get a bill from the Dr for $10.33. Just got off the phone with them, she claims its a co-insurance pay. Is this a new thing??
Co insurance is quite common. It is not new.

I'd verify by looking at your explanation of Benefits to see if this was truly coinsurance, or if the provider is trying to balance bill you, which is a big no no if they are in-network/contracted to your insurance company.
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Old 11-25-14, 04:42 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Thanks for the input everyone... Except for the guy with the live under a rock comment.
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Old 11-25-14, 04:48 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Get angry at Obama.
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Old 11-25-14, 08:12 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

It's common.

So there is the co-pay.
There is the deductible.
Then there is co-insurance.

In another few years there will be an "administrative tax" to pay for Obamacare overruns.

Last edited by NotThatGuy; 11-27-14 at 05:35 PM.
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Old 11-25-14, 08:36 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

And some plans do not have a co-pay at all, it is all D&C
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Old 11-25-14, 08:36 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Shouldn't your job be paying for 100% of your TB test?
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Old 11-25-14, 09:03 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

yes, this is all Obama's fault
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Old 11-25-14, 10:06 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

I roll my eyes that YOUR SHARE alone is over $30 for a lousy TB shot (probably took 3 minutes, and you were in & out in under 5 minutes, right?).

This is something which, even I as a staunch denouncer of Obamacare agrees should be:

1. paid 100% by your 'wellness' yearly visit as part of the ACA.
2. further, paid in full by your employer without you ever even seeing a bill.

So, you've been fucked over, royally, TWICE...

I shudder to think what your Dr. actually has billed insurance for this simple shot... Humor us, won't you, by giving us the full charge?
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Old 11-25-14, 10:17 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

My son was born a little over two months ago and when I skimmed the charges from the hospital there was a charge for 1,200 dollars for medication. My wife wasn't given an epidural during the birth nor did she take any extravagant medication and we were only there for 3 days. Also, I have been looking at getting some Vectical Vitamin D ointment for my psoriasis to replace my old one that is nearly gone and they only go for about 700 bucks for one tube. Tell me that nothing is wrong with our medical system. Insurance companies and hospitals stuff their pockets at our expense.
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Old 11-25-14, 10:23 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by dsa_shea View Post
Insurance companies and hospitals stuff their pockets at our expense.
Insurance is regulated by the government and are restricted with how much they are allowed to make.
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Old 11-25-14, 10:27 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by Music View Post
Insurance is regulated by the government and are restricted with how much they are allowed to make.
Yes, they are but they also make a lot of money off of us for what we pay in every month to have insurance. Insurance is one of the most profitable businesses that exist.
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Old 11-25-14, 11:37 PM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by Music View Post
Insurance is regulated by the government and are restricted with how much they are allowed to make.
they are? maybe I'm just clueless, but I do not believe that is the case (outside of medicare/medicaid of course, which don't restrict how much they can make but do restrict how much they can charge). They're not like a public utility that has to apply for rate hikes. Can you back that statement up?
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Old 11-26-14, 04:56 AM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Is he refering to this?

http://www.hhs.gov/healthcare/insura...ums/value.html

Granted, I don't believe we will ever see a refund....
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Old 11-26-14, 08:28 AM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by dsa_shea View Post
Yes, they are but they also make a lot of money off of us for what we pay in every month to have insurance. Insurance is one of the most profitable businesses that exist.
Not HEALTH insurance.

And really not the case for most other insurance as well.

Originally Posted by LurkerDan View Post
they are? maybe I'm just clueless, but I do not believe that is the case (outside of medicare/medicaid of course, which don't restrict how much they can make but do restrict how much they can charge). They're not like a public utility that has to apply for rate hikes. Can you back that statement up?
Under the ACA all insurance must pay between 80 and 85% of their income to claims. (If I remember the exact number). Again this is health insurance. So yes, profits are capped. Not really an issue since most health insurance companies never made 15-20% in profits. But have the Goverment regulate the profits of a private company is kind of....weird. And who is to say at some point they lower that cap?
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Old 11-26-14, 08:33 AM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by SunMonkey View Post
Is he refering to this?

http://www.hhs.gov/healthcare/insura...ums/value.html

Granted, I don't believe we will ever see a refund....
Refund from who? For what?
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Old 11-26-14, 09:02 AM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by LurkerDan View Post
they are? maybe I'm just clueless, but I do not believe that is the case (outside of medicare/medicaid of course, which don't restrict how much they can make but do restrict how much they can charge). They're not like a public utility that has to apply for rate hikes. Can you back that statement up?
They do have to apply for rate hikes.


Originally Posted by Sdallnct View Post
Refund from who? For what?
From the link above:

Insurers are required to make the first round of rebates to consumers in 2012. If you are owed a rebate you will receive a reduction in your premiums, a rebate check--or, if you paid by credit card or debit card, a lump sum reimbursement to your account. If your employer paid all or part of your premium, the same share of any rebate may go to your employer.
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Old 11-26-14, 09:09 AM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

Originally Posted by Music View Post
They do have to apply for rate hikes.




From the link above:

Insurers are required to make the first round of rebates to consumers in 2012. If you are owed a rebate you will receive a reduction in your premiums, a rebate check--or, if you paid by credit card or debit card, a lump sum reimbursement to your account. If your employer paid all or part of your premium, the same share of any rebate may go to your employer.
Insurance as a whole is arguably the most regulated industry there is. And that was before the ACA. Since then, I'm not sure there can be much arguement.

Every state has a department of insurance and of course there is significant federal oversight as well.

Intersting tid bit, most state insurance departments were started to make sure insurance companies charged enough! To make sure they had enough reserves to pay the claims they promised to pay.

My how times have changed.
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Old 11-26-14, 09:10 AM
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Re: Anyone ever hear of 'Co-insurance' pay for a Dr visit?

It is a very volatile market/industry right now... a good part of that can be attributed to Healthcare Reform.
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