3rd Trimester

NBR: Anyone understand health insurance?

I'm a bit confused and if someone here can explain this to me so I don't have to spend tons of time on hold with our health insurance company, I'd really appreciate it.

 

A week before Thanksgiving, DH sliced open his arm and needed 12 stitches. We paid the $150 co-pay for the ER, no big deal. A couple weeks later we got a bill from the hospital for over $500. At the time, I called the insurance company and was told that it was subject to our deductible. Ok, fine. I paid the bill and moved on. A few days later (who know why) I began wondering and now it's bugging me. If it's subject to our deductible, fine, but why do we have to pay a co-pay as well? Does this make sense?

Re: NBR: Anyone understand health insurance?

  • Co pay is always going to be there. If you have not met your deductible then you are still required to pay the out of pocket amount till the deductible is met.
  • I work for a health insurance company. You will always have your copay no matter if your deductible is met or not. Your deductible is an amount that you have to meet out of pocket before your insurance company will pay at their contracted rate. You also want to make sure you look at your policy to make sure its a yearly deductible and not a "per condition" deductible.
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  • If your plan requires a co-pay, you will have to pay it even when your deductible is met and your maximum out of pocket.

     

  • Thanks ladies. For some reason my brain just wasn't letting go of this one. After spending hours on the phone going over what was covered & what was subject to the deductible for L&D come March, I just really didn't want to go through that again. Especially since I figured it was just me having a moment. Smile
  • Also keep in mind you may also receive a bill from the Doctor who saw you in the ER.  They are able to bill seperately from the facility even after your insurance pays them.  They are not required to take your ins payment in full for their services.

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  • imageJenniferk08:
    Also keep in mind you may also receive a bill from the Doctor who saw you in the ER.  They are able to bill seperately from the facility even after your insurance pays them.  They are not required to take your ins payment in full for their services.

     

    That sucks. The bill for $500+ listed the Dr's services separately from the ER services so I'm guessing that I'm good for this one. I'll be sure to keep that in mind for the future, thanks.

  • There may have been certain portions of the visit that were subject to deductible, like xrays,  bloodwork, professional/surgeon fees.  The copay just covered the actual visit to the ER.  You should have received an explaination of benefits from the insurance company showing the breakdown.  You should also have a booklet(usually u get around beginning of the calendar year) from insurance company that shows how services are covered.
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