How do health insurance deductibles work?

  • by binba
  • Nov 25,2015
  • 2 answers

The definition I know is "the first ___ dollars you pay out of pocket, until your insurance kicks in". But the insurance always kicks in from the first dollar.
For example, I have a PPO with a $500 annual deductible. I go for my first doctor's office appointment of the year. The bill / EOB says $250, and the "discounted network rate" billed was $125. I'm never billed for $125. Rather, the insurance paid for most of it.
CA resident.


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Insurance Answers (2)

Zarnev 6 months ago

Right, you get the negotiated rate even if the insurance actually doesn't pay anything. Your agent can explain this to you fully.

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Master 6 months ago

Almost all practitioners belong to health organisations which negotiate on the fee for it's covered clients. If you REALLY want to be shocked look at the full cost of a hospital bill, then what the hospital ends up with, it's really HUGE!
That's why HMO's and PPO's have provider lists of who you can use. Drugs are worse,LOL.

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