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Explain to me insurance deductibles...

polkadotsockpolkadotsock
in Babies: 0 - 3 Months

I'm so confused. I called my insurance company about getting Mirena and a pump. They said both would be covered 100% if my deductible was met. I keep reading that it's what I pay out of pocket.

So for example, my bill for my labor, delivery and hospital stay was 38 dollars. Is that my deductible? So if my deductible is 300 dollars, then for my BC and pump it would be like 260 dollars all together?

I heard it has to do with copays too? I have a 20 dollar copay but never had to pay it throughout my pregnancy doctor visits...

Baby Birthday Ticker Ticker
Med-free birth, EBF, Co-Sleeping, Babywearer
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Re: Explain to me insurance deductibles...

  • KJmashupKJmashup member

    Copays usually don't count toward your deductible. But you're correct in your thinking that if you've already paid $38 toward your deductible, then you have to meet another $262 before your plan picks up whatever percentage it pays.

    So if your plan pays 80% after your $300 deductible is met, then what ever portion of your pump that exceeds the $300 will be paid at 80%, leaving you to pay the 20% balance.

    Be sure you get all of this done before the end of the year, or else your deductible starts all over again. 

    "To me, you are perfect."
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  • emilydholmes1emilydholmes1 member
    imageKJmashup:

    Copays usually don't count toward your deductible. But you're correct in your thinking that if you've already paid $38 toward your deductible, then you have to meet another $262 before your plan picks up whatever percentage it pays.

    So if your plan pays 80% after your $300 deductible is met, then what ever portion of your pump that exceeds the $300 will be paid at 80%, leaving you to pay the 20% balance.

    Be sure you get all of this done before the end of the year, or else your deductible starts all over again. 

    Yes. You definitely want to move fast otherwise in January you would have to start all over. Hate that!

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  • polkadotsockpolkadotsock

    Ooh... okay! Thank you so much! I'm sitting here trying to read and understand what it means. And I had no idea it starts over at the start of a new year...

    *runs off to make a doctor appt.*

    Baby Birthday Ticker Ticker
    Med-free birth, EBF, Co-Sleeping, Babywearer
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  • KJmashupKJmashup member
    imageKJmashup:

    Copays usually don't count toward your deductible. But you're correct in your thinking that if you've already paid $38 toward your deductible, then you have to meet another $262 before your plan picks up whatever percentage it pays.

    So if your plan pays 80% after your $300 deductible is met, then what ever portion of your pump that exceeds the $300 will be paid at 80%, leaving you to pay the 20% balance.

    Be sure you get all of this done before the end of the year, or else your deductible starts all over again. 

    Sorry, I forgot that you said your plan pays 100% after deductible. So disregard my bolded paragraph. 

    "To me, you are perfect."
    image

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