Quote:
Originally Posted by lubby
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.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Health Insurance 101
