can some one please explain how the deductible works?
@moonlitmagikchild (22181)
United States
December 20, 2008 10:09pm CST
getting new health insurance and of course confused as hell!! i know in the past when ever i had a deductible it always was like "after you pay X amount (the deductible) in copays you wont pay anymore" but hubby swears its saying they wont pay for anything till we pay that much which i remember i had thought that in the past and almost switched jobs because i thought that the insurance is gonna be that way..
who is right? is the deductible the max amount you will pay out in copays or the deductible what you will pay till it is met then you only pay copays?
this is all about blue cross and blue shield health insurance
2 people like this
10 responses
@mindym (978)
• United States
21 Dec 08
When I had insurance at my last job, we had the worst insurance ever. But we had to meet a $2000 deductibe and once we met that, then the insurance company would pay 70% and we would have to pay 30%. Many copanies are going with insurance where you have a deductible. I miss the days when I was on my Dad's insurance and I had a reasonable co-pay and that was it. No deductible to meet.
2 people like this
@Melitta (32)
•
21 Dec 08
We have BCBS CA, it is now Anthem. Ours is a $20 copay with a $150 deductible up to 3 people. Meaning, we have 5 people on our insurance, but only 3 of them have to meet the $150 deductible. When we go to the doctor we pay our $20 copay upfront, then when we get our EOB (Explaination of Benefits) from the insurance company it will tell me the total price of the visit, how much is my responsibility (which is usually just my copay) and what ISN'T my responsibility. Read over your booklet with a fine tooth comb. If we had X-rays and had not meet the deductible for the person having the X-rays done, the X-rays were covered, but not the "reading" of the X-rays. Your booklet should break down what is covered 100%, minus your copay. If you have any questions call BCBS and MAKE them explain, if you feel you have someone who doesn't know what they are talking about (and you will get some like that) call back again. Use your human resource person at work also, they should the insurance plan inside and out. I have an advantage, my friend works for a company that does insurance claims. Everytime I get an EOB saying that I owe money, I show it too her and she calls Athem and asks for specifics on the charges. She has had so many of my EOB's resubmitted and charges taken off, that she has saved me about $300 that I would have paid and wasn't suppose too. Billing can get screwed up, so ask questions, questions and more questions.
I must say this will all depend on your plan with BCBS. We have the High Option, which we pay more for montly, but less out of pocket for visits. I know they also have the Mid Option, which is 80% of your visit covered.
Also be sure to stay with an In-Network doctor or only 50% of your visit is covered. Oh, and our copay DOES NOT go towards our deductible.
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@moonlitmagikchild (22181)
• United States
21 Dec 08
yeah as soon as he is hired im gonna have him talk to them.. it was stupid because he hasnt been hired yet but is going to be so they went ahead and let him go to the benefit thing..
@sedel1027 (17846)
• Cupertino, California
21 Dec 08
Usually you have what is called Max. out of pocket (or something similar) so once you pay that much out of pocket (in copays or for stuff the insurance doesn't cover) then the insurance covers everything.
2 people like this
@moonlitmagikchild (22181)
• United States
22 Dec 08
thats what i thought.. like after the copays add up to X amount then everything is covered
@shooie (4984)
• United States
21 Dec 08
Well if we are told we have a $500 deductible on the car repairs it means we have to pay the first $500 that year. Now my stepdaughter when she was working her insurance was a $500 deductible. When they would take their kids in for check ups or if they got sick they had to pay the visits and medications until the total reached $500 for that year. So if they are/were sick in january and febuary and reach the deductible then all they have the rest of the year are co-pays and the rest of the bill is picked up. I hope this helps and I am not way off base.
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@moonlitmagikchild (22181)
• United States
21 Dec 08
ugh thats what my hubby thinks and if so im screwed
@relundad (2310)
• United States
21 Dec 08
Of course they have several different plans and all of them work differently. I used to have BCBS a couple of years ago and the co-pays were not associated with the deductible at all. The deductible was on the portion of the medical bills that were not covered by a co-payment. For instance a doctor's visit is covered 100% after co-payment. But other services they may only pay 80%, well they would only pay 80% after you had met your annual deductible.
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@moonlitmagikchild (22181)
• United States
21 Dec 08
i hope that is how this one is because i cant afford it to be any other way
@nikkij2079 (126)
• United States
21 Dec 08
A deductible is usually for hospital stays depending on the company. When you go to the doctor yo will always pay a copay even when the deductible is met. Once the copay is met the insurance will pay the rest of the bill. Copay and deductible are two different payments. Hope this helps.
@nixxi76 (3191)
• Canada
22 Dec 08
Usually a deductible is when you pay that certain amount that you have to pay then you get the rest covered.
I know with car insurance that's how it goes. Mine is set at $200.00 deductable so if I get into an accident and my truck is messed up bad, I will have to pay that $200.00 and the rest is covered
Hope this helps!
Merry christmas
1 person likes this
@saundyl (9783)
• Canada
21 Dec 08
With my car insurance the deductible is paid before insurance will pay for anything. (which sucks because my deductible is 700 dollars.) My health insurance we get from work (starting last week - awesome Christmas bonus eh!) has no deductible.
I think your husband is right that you have to pay that total THEN the insurance pays)
1 person likes this
@avidwhit (1492)
• Mexico
22 Dec 08
I know for car insurance the deductable is what you have to pay first, then whatever the is over the deductable is paid by them. If its a $1000.00 door and window ruined on your BMW car when a burgerly trashs it while trying to rob your car stereo. And your deductable is $250.00 then your pay $250.00 and your insurance company pays $750.00. The co. pays anything over and beyond the deductable. Usually the higher the deducatable the lower the monthly rate. In other words the more you agree to pay in the case of need/emergecy the the less they will charge you for it now. Heheehhhehe I can go on and on about this kind of thing. Opps Pardon Porfavor :) I know of people who never invest insurance and use that cash for other investments such rental units botique shops etc. Diff strokes diff folks. These are 2 reputable companies you are looking into I beleive. Reputable as heard of only not guarrantee of success. They have been around for awhile.
1 person likes this
@moonlitmagikchild (22181)
• United States
22 Dec 08
well i am one to always get and keep insurance but this new jobs insurance is looking pretty crappy and i dont know if i can afford it to be 2x as much a month then really crappy coverage.. oh well.. i will figure something out
1 person likes this
@lillylangtree (23)
• United States
22 Dec 08
A deductible is totally different than the copay. These are two different types of plans. First of all, if your plan requires that you pay a deductible (that is the amount you pay out of your own pocket up front before the insurance will pay anything). Depending upon the plan, after you met or have paid your deductible, the insurance will pay a percentage of your medical or dental costs depending upon the plan. For instance a common plan is $100.00 deductible and after that the plan might pay 80% for a Doctors visit and often will pay 100% of a hospital stay for so many days.
If you have a copayment, there is usually no deductible and the copayment would be required for any Drs. or Dentist visit. It could be $10.00 per visit depending upon the plan, then the insurance would pay the balance. This type of plan doesn't usually give you as many choices of Docs to see as often they have to be providers of the said plan and not all Doctors like this type of plan as typically it doesn't pay as much, however, many Doctors are members of these plans. I hope that helps.
1 person likes this
@moonlitmagikchild (22181)
• United States
23 Dec 08
well this one is like a $1,000 dollar deductible per person then 80/20 then $35 dollar copay.. all listed on the same plan which has me totally confused because i have never been told all 3 in one plan before.. and out of the three different plans to choose they all have all three listed..