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Old 12-30-2011, 06:00 PM
 
Location: In a house
13,258 posts, read 34,707,116 times
Reputation: 20198

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Quote:
Originally Posted by lubby View Post
Wow!! That's alot of money for a Doctors visit. I have never heard of this type of plan you have. We have oxford and a visit to a specialist is $50.00 and our regular MD is $30.00. Good Luck Disputing the bill.
The "plan" s/he has isn't a plan. It's a payroll deduction that gets put into a savings account pre-tax and earmarked for medical expenses. S/he doesn't get to pay co-pays, s/he pays full price, because it's not insurance.
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Old 12-30-2011, 06:10 PM
 
Location: Tigard, Oregon
854 posts, read 2,481,871 times
Reputation: 656
Quote:
Originally Posted by AnonChick View Post
The "plan" s/he has isn't a plan. It's a payroll deduction that gets put into a savings account pre-tax and earmarked for medical expenses. S/he doesn't get to pay co-pays, s/he pays full price, because it's not insurance.
Correct, but:
1. You have to have a High Deductible Health Insurance plan to have an HSA. They go hand in hand. So they most likely DO have a plan. OP likely made a mistatement.
2. "Full price", not necessarlily. Most "plans" do have contracted pricing with discounts.
3. High Deductible Plans are insurance and can have copays for wellness benefits (ours does) but likely does not for Dr Office visits.

The "high" deductibles are in the thousands, hence the HSA to pay for the higher out of pocket expenses. High deductible plans tend to have cheaper premiums for employers. Ours funds a portion of the HSA with the savings. It puts the insured in the drivers seat because if you don't spend the money eventually you get to keep it. Alternatively you don't get to see a Dr for $30.
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Old 12-30-2011, 06:35 PM
 
Location: Georgia, USA
21,569 posts, read 26,201,545 times
Reputation: 26618
Default Health Insurance 101

Quote:
Originally Posted by lubby View Post
Wow!! That's alot of money for a Doctors visit. I have never heard of this type of plan you have. We have oxford and a visit to a specialist is $50.00 and our regular MD is $30.00. Good Luck Disputing the bill.
Insurance plans which include Health Savings Accounts (HSAs) allow people to use tax deductible funds to pay some medical expenses. In exchange for choosing a high deductible (at least $2400 for 2011), you pay a lower monthly premium.

See here for how HSAs work.

http://www.irs.gov/pub/irs-pdf/p969.pdf

When you see a doctor under the plan that you have, lubby, you are charged a co-payment for each visit. That is the $50/$30 that you are referring to. That is not the only payment the doctor receives for the visit, however. The doctor sends the claim to your insurance company, which has agreed to pay a certain amount for the type of visit you had. That is typically significantly less than the doctor's fee which would be charged to someone with no insurance at all.

Let's say that you see Dr. Derm to have him evaluate the dohickey your primary care doctor is concerned about. Dr. Derm's staff check you in, you fill out a history form, his nurse puts you in an exam room, and Dr. Derm looks at the dohickey. He decides it should be removed, and does that with a little local anesthetic.

He fills out a form that tells his check out clerk the level of complexity of the visit and the name of the procedure he did.

Charges are then generated. For a new patient visit for someone with your condition, let's say the charge is $250. Removing the dohickey is another $100. That's a total of $350.

But Dr. Derm and your insurance company have agreed he will accept $125 for the visit fee and $50 for doing the biopsy. That is a total of $175.

Your copay, since Dr. Derm is a specialist, is $50, which you pay before you leave the office.

When the insurance company receives the claim for the visit, it sends Dr. Derm $125: the negotiated fee of $175, less the copay of $50 from you.

Your out of pocket cost is only $50. Or is it?

Your insurance probably also has a deductible. That is the amount you must pay before the insurance will pay anything for any visit. If you have a $500 deductible and you have not paid all of that amount for other medical care, you may owe some or all of the $125 remaining on your bill. The insurance company will notify Dr. Derm, and he will send you a bill for the additional amount. If you have a $500 deductible, and you have only paid $400 of that, you still owe $100 towards your deductible. You pay your $50 copay, the insurance company sends Dr. Derm $25 ($125 minus $100), and Dr. Derm sends you a bill for $100.

Someone like the OP, with a high deductible, may not ever meet his entire deductible.

In general, if you choose a plan with a higher deductible and higher copays, you pay a lower monthly premium.

Some plans are different, perhaps paying a copay that is a set percentage of the negotiated fee rather than a flat rate.

After the insurance company processes the claim, it sends you an "Explanation of Benefits" (EOB) that explains what the charges were and how much you owed, including your copayment and any deductible amounts, and whether you still owe anything to the doctor. That amount should match the bill that Dr. Derm sends to you.

Your doctors will appreciate it if you keep track of your deductible. You can often do that through your insurance company's web site, and it will be on every EOB you receive. If you still owe on your deductible, you can save the doctor the cost of billing you for that amount by paying it at the time of your visit.

The rules for hospital care are different and vary with the individual plan.

If you are not sure how your insurance works, someone in Human Resources for the company through which you are insured can explain it to you.

How about a patient with no insurance? Dr. Derm would charge the entire $350.
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Old 12-30-2011, 08:38 PM
 
Location: Tigard, Oregon
854 posts, read 2,481,871 times
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Quote:
Originally Posted by suzy_q2010 View Post
If you still owe on your deductible, you can save the doctor the cost of billing you for that amount by paying it at the time of your visit.
Wow. great, thorough post!

You make a good point of "paying up to your deductible at the time of your visit." However, because of contractual adjustments, and if you have other charges pending, this is impossible to accurately guess at the time of service. Even if you have met your deductible, balance billing (after the claim is processed) is the only way to know your final financial obligation. I'd rather underpay and catch up, than overpay as that is a different pain, especially with an HSA.
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Old 12-30-2011, 10:25 PM
 
Location: Islip,NY
16,959 posts, read 19,737,674 times
Reputation: 17230
Quote:
Originally Posted by AnonChick View Post
The "plan" s/he has isn't a plan. It's a payroll deduction that gets put into a savings account pre-tax and earmarked for medical expenses. S/he doesn't get to pay co-pays, s/he pays full price, because it's not insurance.
Oh I see. Latley we have been to doctors for follow ups and they have been waiving our co-pays. I am fortunate though because my husband's boss pays for our medical in full for the two of us. We just pay for Rx's , co-pays and an ER co-pay which is $150.00 if we go there and don't get admitted.
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Old 12-31-2011, 06:31 AM
 
Location: In a house
13,258 posts, read 34,707,116 times
Reputation: 20198
We have a PPO too lubby (sounds like what you have). $5 for doctors' office visits, $50 for ER outpatient, $150 for admission (the $50 outpatient is applied to that), and $5 for 90-day supplies of prescription drugs via mail-order. We don't pay anything for the plan itself and we're both covered.

I have a relative who has no insurance at all though and they tell me horror stories.
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Old 12-31-2011, 09:35 AM
 
Location: Islip,NY
16,959 posts, read 19,737,674 times
Reputation: 17230
Quote:
Originally Posted by AnonChick View Post
We have a PPO too lubby (sounds like what you have). $5 for doctors' office visits, $50 for ER outpatient, $150 for admission (the $50 outpatient is applied to that), and $5 for 90-day supplies of prescription drugs via mail-order. We don't pay anything for the plan itself and we're both covered.

I have a relative who has no insurance at all though and they tell me horror stories.
My Rx co-pays are higher than that, I pay through mail order about $35.00 for my husbands synthroid and for Zoloft I pay abot $20.00 for 3 months. My Doctor visit's are $30.00 but for a specialist it's $50, ER out patient $150. I think Health insurance rates are higher in NY.
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Old 12-31-2011, 12:30 PM
 
Location: Boonies
1,775 posts, read 2,593,512 times
Reputation: 2312
Quote:
Originally Posted by lubby View Post
Oh I see. Latley we have been to doctors for follow ups and they have been waiving our co-pays. I am fortunate though because my husband's boss pays for our medical in full for the two of us. We just pay for Rx's , co-pays and an ER co-pay which is $150.00 if we go there and don't get admitted.

I was under the impression that it was illegal for physicians who have contracts with insurance companies to waive a patient's copay unless there is a proven financial hardship. Any other billers out there care to comment?
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Old 12-31-2011, 01:06 PM
 
Location: Islip,NY
16,959 posts, read 19,737,674 times
Reputation: 17230
Quote:
Originally Posted by tarragon View Post
I was under the impression that it was illegal for physicians who have contracts with insurance companies to waive a patient's copay unless there is a proven financial hardship. Any other billers out there care to comment?
I have no Idea, and I don't care. 3 times I went to the doctor this past month for my husband and they never asked for a co-pay. I found it odd but I didn't question it.If we do get a bill then we will pay it.
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Old 12-31-2011, 04:42 PM
 
Location: Coastal Connecticut
14,762 posts, read 17,997,574 times
Reputation: 3340
My deductible was $2000 and I didn't come close to that.
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