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question about health insurance coverage

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question about health insurance coverage

Old 06-24-16, 09:31 PM
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question about health insurance coverage

I have (what I think is) good health insurance through my wives government job. I have to get an MRI and I called the place up that my doctor referred me too.

She took my insurance ID # and said she would call to confirm coverage before scheduling anything. She called me back surprisingly quick and said we were good to go and we scheduled for next week.

My question is do I have anything else to be weary of? I hear insurance/health horror stories where people are hit with $10000 bills afterwards. Do I need to call the insurance company myself just to be sure? Can they just lie and screw me later? Or find some loophole and say I owe everything?
Old 06-24-16, 09:41 PM
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Re: question about health insurance coverage

just call your insurance. or go online. they should have an explanation of benefits and costs associated with certain treatments.
Old 06-24-16, 09:43 PM
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Re: question about health insurance coverage

You need to contact the insurance company. Ask them these things:

What is the reasonable and customary reimbursement for an MRI? That tells you how much they will pay the radiologist who does the MRI.

What is your deductible for 2016 and has it been met?

What is your out-of-pocket maximum for 2016 and has it been met?

I would doubt very much, if you have good insurance, that your deductible is more than $2500-5000. Your out-of-pocket max will probably be about the same. That's how my policy is, anyway (I have United Health Care and thanks to a December 31 accident have run up about $160K so far this year, so I'm unhappily familiar with this issue ... haha).

You could also contact the radiologist again and see how much they are going to bill for the MRI. They are used to people wanting to know this stuff so don't be embarrassed.

Good luck!
Old 06-25-16, 09:27 AM
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Re: question about health insurance coverage

If your Dr accepts your insurance, then you "should" be in good shape. Dr's know they are not going to get paid by the patient. That is why they get pre-approval for expensive treatments. The Dr likely had to provide a report as to why this was needed.

For example when I thought I had a stress fracture, my Dr first did a standard X-Ray. She did so saying it probably won't show up but that is evidence that an MRI is needed.

Having said all that, yes call your insurance company. Verify the pre-approval. And might as well ask about your deductible/co-pay etc.

Remember, you are the Customer and the patient. You have the right to be informed and clear on cost/coverage/out of pocket expenses, etc.
Old 06-25-16, 11:50 AM
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Re: question about health insurance coverage

What Miss Vibiana said is the best advice, I work with this everyday, and people will get billed and say I have insurance why am I getting a bill, and I have to explain that they have a deductible, or co-insurance, so please call your insurance company and ask, and don't always believe the doctors office, they mostly call to see if your insurance is in effect on the day of service, and any estimate that they give you is usually wrong. Good Luck
Old 06-29-16, 08:02 PM
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Re: question about health insurance coverage

thanks for all the help.

so I made the calls and what ive figured out is this (I hope this is right):

my deductible is $350. the max they could charge me for the MRI is $775 and I owe 15% after I meet the deductible. I paid about $180 for some medical services earlier this year so if my math is correct I will now owe...

($350-$180) = $170 plus 15% of the remaining which would be (15%)($775-$180) = ~$90 for a total of ~$260. does this sound about right?

another question: are deductibles per person or per plan/family? I am on my wifes insurance as is my son - does the $350 have to be met by all of us combined or each of us has $350 deductible?
also when does it reset? january 1st?
Old 06-29-16, 08:50 PM
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Re: question about health insurance coverage

If your deductible is only $350, you have REALLY good insurance.

Originally Posted by atari2600 View Post

another question: are deductibles per person or per plan/family? I am on my wifes insurance as is my son - does the $350 have to be met by all of us combined or each of us has $350 deductible?
Could be either depending on your insurance policy. Call them back and ask if it's an individual deductible or a family deductible. Or if they have a website you can log onto with your policy information, you can probably find the info right there
also when does it reset? january 1st?
Usually, yes.
Old 07-09-16, 05:30 PM
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Re: question about health insurance coverage

To be certain of obtaining accurate and reliable information, you should be posing these and all other insurance related questions to your insurance carrier, not an internet forum of people who know nothing about your specific policy. Jeez.

Last edited by Jack Straw; 07-09-16 at 07:06 PM.
Old 07-09-16, 05:52 PM
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Re: question about health insurance coverage

Anything medical these days is a true nightmare! If this is any indication of the goddamn hoops one must go through for a 'simple', even routine procedure, just to be sure of where you stand, then what happens when you're REALLY sick and can't do all of this sleuthing?

The Doc / hospital / outpatient people / insurance companies seem then to get carte blanche to collude and completely screw you over, even WITH insurance!

God help us, I'm really glad I haven't had to go through any of this bullshit yet. It does give a truly compelling reason to seriously leave the country... It probably will just get worse under Prez Hillary (for the Middle class, that is...)

Is there ANY sanity in Medical Care in the USA these days?? Serious question.
Old 07-10-16, 02:18 AM
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Re: question about health insurance coverage

Originally Posted by zyzzle View Post
Anything medical these days is a true nightmare! If this is any indication of the goddamn hoops one must go through for a 'simple', even routine procedure, just to be sure of where you stand, then what happens when you're REALLY sick and can't do all of this sleuthing?

The Doc / hospital / outpatient people / insurance companies seem then to get carte blanche to collude and completely screw you over, even WITH insurance!

God help us, I'm really glad I haven't had to go through any of this bullshit yet. It does give a truly compelling reason to seriously leave the country... It probably will just get worse under Prez Hillary (for the Middle class, that is...)

Is there ANY sanity in Medical Care in the USA these days?? Serious question.
While I generally don't agree with the ACA, one thing it did was bring consistency. All policies pretty much cover the same things (and don't cover the same same things). The main differences in policies is with out of pocket expenses.

Of course the advise to check with your own insurance company is sound. You should also be able to get or find a "summary" of coverage. Won't be all inclusive as it is just a summary, but should cover the most common questions.
Old 07-10-16, 06:21 AM
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Re: question about health insurance coverage

A good doctor's office will let you know. They deal with insurance companies all day long.

I went to a dental surgeon last week to see about getting a broken-off tooth removed and a screw put into its place. By the time I got out an hour later, the receptionist told me that insurance would pay for the removal, but they will pay 0% towards an artificial tooth.

I'm angry. I've spent ten years and thousands of dollars to adjust my bite. I'm not going to undo all that by leaving a gap for my teeth to lean into.
Old 07-10-16, 06:43 AM
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Re: question about health insurance coverage

Originally Posted by Nick Danger View Post
A good doctor's office will let you know. They deal with insurance companies all day long.

I went to a dental surgeon last week to see about getting a broken-off tooth removed and a screw put into its place. By the time I got out an hour later, the receptionist told me that insurance would pay for the removal, but they will pay 0% towards an artificial tooth.

I'm angry. I've spent ten years and thousands of dollars to adjust my bite. I'm not going to undo all that by leaving a gap for my teeth to lean into.
Well, there ya go, it's such a racket, even with the ACA, which I generally don't agree with also.

I don't even bother with Dental insurance, for reasons like you've just found out.
Old 07-10-16, 07:07 AM
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Re: question about health insurance coverage

No dental insurance that I'm aware of will pay for an implant. Usually they will pay a portion toward a bridge, but the location may not always be suitable for a bridge.
Old 07-10-16, 09:45 AM
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Re: question about health insurance coverage

Originally Posted by Nick Danger View Post
A good doctor's office will let you know. They deal with insurance companies all day long.

I went to a dental surgeon last week to see about getting a broken-off tooth removed and a screw put into its place. By the time I got out an hour later, the receptionist told me that insurance would pay for the removal, but they will pay 0% towards an artificial tooth.

I'm angry. I've spent ten years and thousands of dollars to adjust my bite. I'm not going to undo all that by leaving a gap for my teeth to lean into.
You can't trust a medical care provider to be right though. My daughter had to have a wisdom tooth removed. At the time they also decided to do a biopsy. Turned out insurance covered the wisdom tooth but not the biopsy, so I got stuck with an $800 bill when I'd been expecting about a quarter of that.

It was then that the office told me they only checked coverage as a service, and didn't guarantee their results.
Old 07-10-16, 10:55 AM
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Re: question about health insurance coverage

Tasha's daughter had her wisdom tooth removed. I'm having an old-age moment.

It's like when I learned that penis chair boy had a driver's license.

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