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Old 08-20-2016, 01:52 PM
 
41 posts, read 21,748 times
Reputation: 24

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Hi,

I am really confused about American's health plan. I use UPMC PPO plus plan.
The deductible is 750 annually.
It covers 80% after deductible.
So for per visit, I should pay in full if it is below 750?

for example, the bill is 1000, I shuold pay 750+(1000-750)*20%???

Anyone can give me a hand here?

Thank you!
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Old 08-20-2016, 07:56 PM
 
7,910 posts, read 9,116,589 times
Reputation: 9277
Quote:
Originally Posted by dbwindyusa View Post
Hi,

I am really confused about American's health plan. I use UPMC PPO plus plan.
The deductible is 750 annually.
It covers 80% after deductible.
So for per visit, I should pay in full if it is below 750?

for example, the bill is 1000, I shuold pay 750+(1000-750)*20%???

Anyone can give me a hand here?

Thank you!
You will get an explanation of benefits (EOB) from the insurance company for each medical visit you have. It will explain how much of the bill is subject to the deductible and what you owe the provider. You then will get the bill from the provider that should say the same thing as the EOB from the insurance company.

Remember to stay in network, that is make sure all of your providers are in network for your insurance company.
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Old 08-20-2016, 08:55 PM
 
Location: OH>IL>CO>CT
7,490 posts, read 13,543,400 times
Reputation: 11853
Quote:
Originally Posted by dbwindyusa View Post
Hi,

I am really confused about American's health plan. I use UPMC PPO plus plan.
The deductible is 750 annually.
It covers 80% after deductible.
So for per visit, I should pay in full if it is below 750?

for example, the bill is 1000, I should pay 750+(1000-750)*20%???

Anyone can give me a hand here?

Thank you!
In a given plan year, your math is correct for the first visit of the year.

Any visits after that you should not be charged the 750 again, only the 20% of the approved charges.

The 750 deductible is once per year, not per visit.
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Old 08-21-2016, 04:08 PM
 
2,957 posts, read 5,886,263 times
Reputation: 2286
OP. That's correct and like the other poster mentioned the $750 is per year. You probably have an out of pocket maximum too to cap your maximum loss per year.

A $750 deductible is pretty good. Mine is $3K, but the company gives us the 1st $1K (it's for the family).
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Old 08-24-2016, 05:27 AM
 
3,613 posts, read 4,104,291 times
Reputation: 5008
Quote:
Originally Posted by dbwindyusa View Post
Hi,

I am really confused about American's health plan. I use UPMC PPO plus plan.
The deductible is 750 annually.
It covers 80% after deductible.
So for per visit, I should pay in full if it is below 750?

for example, the bill is 1000, I shuold pay 750+(1000-750)*20%???

Anyone can give me a hand here?

Thank you!
Maybe...do you have any co-pays listed in your plan documents? What is the visit for? If it is for an annual physical, you won't pay anything for that visit as long as it is only for the annual physical. Yes, typically if you have a deductible you pay that first before the plan starts paying it's portion, but to fully answer this, we need more details about your plan.
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