by Guest » Wed Jan 14, 2009 04:05 pm
I'm curious if there exists such a policy in which there are no copays, no networks, just a flat deductible in which the client is free to go to whichever doctor they choose, pay the full cost of the visit and report the expense to their insurer. Once they've hit the deductible, the insurance kicks in for the full cost of treatment. Essentially true "catastrophic only" coverage. I realize that in the current HDHP world the plans work similarly but are still encumbered by in-network/out of network deductibles as well as network maintenance on the part of the employer. AFAIK this is the way insurance worked historically before the advent of managed care.
Posted: Thu Jan 15, 2009 09:38 am Post Subject:
Deductible only health insurance? not that I'm aware of but this board has some great health insurers who would definitely be around with suggestions. However, the idea of co-pay was introduced to minimize the misuse of health coverage by the policy holder. Co-pay urges the policy holder to share the medical expenses with the insurer and makes hi responsible towards the use of the policy.
Posted: Thu Jan 15, 2009 10:58 am Post Subject:
I thought deductibles were about bearing a percentage of the losses or damages by the policy holder. A flat deductible would let the policy holder share a fixed amount for different hospitalization expenses. I don't think that's ever possible in this expensive world of harsh medical billing. Insurance companies are not there for charity services, they're there to earn as well.
Posted: Thu Jan 15, 2009 12:03 pm Post Subject:
The POS plan under the managed care plan does allow the doctors listed in the network to refer you to a specialist of your choice who isn't listed , but in that case you are expected to pay a co-insurance which isn't the case if the referred doctor also forms part of the network of listed doctors.
To minimize your costs further , I believe you can also opt for the PPO.Here, if you choose to visit a doctor from outside the network then you would only have to pay the differential.
Posted: Thu Jan 15, 2009 09:07 pm Post Subject:
In the current high deductible health plan setup, the client pays a large portion of the total cost of services. That cost is a pre-negotiated rate agreed upon by the physician and the network administrator. In this model there is no need for copays as the purpose is to lower premium by increasing the percentage of cost the client is responsible for. However the limitation is that the client is still obligated to goto a network doctor or they will be subject to an out of network deductible, which is considerably higher than the in-network deductible. I don't think I was very concise with my initial post but the point would be to remove that "hidden" cost and essentially allow the client to visit whoever they want. The only variable is the cost as they would not be operating under pre-negotiated rates, and would need to prepare accordingly. Again it is essentially true catastrophic only coverage without the frills associated with other plans, which would result in a lower premium. The kicker would be to provide a system to allow the client to "negotiate" their own rates for costly services.
IMO the purpose of copays is to require the client to be responsible for some of the toal cost, but not nearly as much as in a typical HDHP plan, hence why HDHP's have lower premiums than typical copay plans. It's just a different balance of risk. In return for shouldering more of the cost, the insurance company offers a lower premium.
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