Urgent question regarding interpreting explanation of health insurance deductibles...?

  • by Fandrew
  • Nov 25,2017
  • 5 answers

Hoping someone in the health insurance industry or familiar with terms and explanations regarding meeting plan deductibles can help interpret and explain how this particular policy handles the deductible. Husbands employer will not speak to me and husband has no clue what to ask and just found out that his employer needs our reply by Monday morning and insurance provider is closed until Monday. Please help!


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Insurance Answers (5)

H. Marie 2 weeks ago

if you have a deductible amount you can select how much you are prepared to pay for any services you need during the year with the insurance company paying the remainder
you can select a low deductible but your premiums will be higher, or you can select a high deductible and your premiums will be less
I am not aware that any medical insurance pays 100% of any procedure, the patient will always pay something, possibly 20% of the bill and the deductible amount

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A Hunch 2 weeks ago

You don't ask a question, so I'm going to guess what you are asking.
A health insurance deductible is no different than a car insurance deductible.
- It's the amount you are responsible for paying before the insurance begins providing coverage.
- some treatment is not subject to the deductible and insurance will pay before you have met the deductible.

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amy lynn 2 weeks ago

The plan deductible is the amount of money that you will pay for medical services before your plan starts to help pay for your medical bills.
Example: You go to the doctor and it costs $200. The doctor files a claim with your insurance, but your insurance just applies it to your deductible and notifies the doctor. The doctor then bills you and you would need to pay the doctor $200. If your deductible is $1000 for the year, that reduces the deductible by $200, and now you have $800 more in medical expenses to cover out of your own pocket before your insurance helps you pay for your medical expenses.
You didn't list the amount of deductible or any other details about the plan, so I just tried to describe how a deductible works. You don't need to pay the deductible amount up front. You don't even pay anything on the deductible until you have a medical bill. Then you pay the bill and the amount of the bill is removed from the deductible that you still "owe." If you go for the whole year without using enough medical expenses to reach your deductible, then nothing happens at the end of the year other than your insurance never actually helped pay for any of your medical expenses for the year. The deductible just resets at the beginning of the next year.

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lucy 2 weeks ago

My guess what your husband has to decide is (which) deductible to choose.
The higher the deductible, then the cost for the insurance will be lower. So say for instance he has a choice of $1,000, $2,000 and $2,500 deductible. For each deductible, then they would show (how) much they will deduct from your husbands paycheck.
So the $1,000 is $50 each paycheck, the $2,000 is $37 and the $2,500 is $25.
Now you need to decide (how) much medical treatment that (each) of you might have in (1) year. If both of you rarely go to a doctor, then best to have the higher deductible and pay less. But, if you go to a doctor/specialist a lot, then may want the lower deductible and pay more.
So for (every) time you go to a doctor, get lab tests etc, then they bill the insurance. The insurance company will have a “negotiated” rate that is lower than (if) you paid cash and no insurance. So for the doctor and lab tests they bill $500, then insurance reduces it to $400, then you pay $400 out of your pocket and that $400 is (subtracted) from the deductible.
Once your medical bills are (more) than the deductible, then insurance starts paying.

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Insurance Pickle.com 2 weeks ago

To add on to the answers. You could be looking at two different deductibles (or more) with different plans, but HOW they treat the deductibles can be completely different. The example above gives and example of going to the doctor. That MAY be correct, but maybe the plan doesn't have a deductible for office visits. You need to read the benefits summary. It'll give you an amount or percentage you pay. AND, most importantly, it'll likely say "AFTER DEDUCTIBLE" meaning you'll have to pay an amount equal to the deductible in medical expenses (services that you rec'd) before that's treated that way.
Quick example. Visit could say $20 copay after deductible (let's use $1,000 as a deductible for the example). So, you pay for the full price of your visits until you've spent $1,000. After you've spent $1,000 of medical expenses, your visits would then be covered by the $20 copay. Another option is that it could just read "$20 copay," so one would assume you would NOT have to meet the deductible in that case. So, even though you have a $1,000 deductible, the first visit would be covered by a $20 copay. In that case other services could be subject to the deductible. Anyway...nobody here would know how your plans treat deductibles. You HAVE to look at the summaries. If you don't have summaries, then you can't make a choice. It's that simple, because you don't know what you're deciding upon.

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