Help with high deductible health insurance

Submitted by frtwome on Tue, 01/20/2009 - 18:31

I have a 5,000. deductible on my health insurance that I have to pay first, but when I go into the doctor, do I still give them my insurance card, even though it will not be covered?

Posted: 20 Jan 2009 08:29 Post Subject:

Depends... do you still have some type of network requirement, etc.? There are not many plans out there with this high of a deductible that don't also have some expenses covered at 100% or with a small co-pay (such as preventative care). If you just have a $5000 ded, then I suppose you do not need to present a card. But I'd still call your health insurance company and ask them.

Posted: 20 Jan 2009 11:22 Post Subject:

I have a 5,000. deductible on my health insurance that I have to pay first, but when I go into the doctor, do I still give them my insurance card, even though it will not be covered?

Many health insurance programs have a co-pay for doctor's office visits, maybe $20 - $40. Surely you don't have a $5,000 deductible on all medical care and treatment.

If you have a doctor's visit co-pay, it should be shown on the face of your ID card or in the health insurance policy.

Yes, give them your insurance card. Even if you do have a flat $5,000 deductible on everything, this will let your insurance company know that you have satisfied at least a portion of the deductible.

Posted: 21 Jan 2009 07:06 Post Subject:

Okay, since its a flat annual deductible and you keep paying small amounts at every doctors' visit you are achieving the high deductible rate. Hence, you may have to pay less as deductible if some major health issue arises at the end of the term of the plan, or am i get it wrong?

Posted: 21 Jan 2009 02:19 Post Subject:

When you go to the doctor with a high deductible plan, you're paying a portion of a pre-negotiated (network) rate, there are typically no copays and no up front costs. The way it works with mine (Golden Rule $5600 deductible), I go to the doctor and pay nothing. The doctor bills by insurance co for the negotiated amount, and I get a bill for the balance in the mail. To answer your question, yes, always give them your insurance card so they know how to bill, but don't expect to pay anything when you go to the doctor, you'll be billed later.

Bandit Baby: Yes, every dollar you spend going to the doctor counts towards your deductible. The point of high deductible plans is really catastrophic coverage. You pay more for each visit but in return pay lower premiums than you would on a regular copay plan. The thing to remember is that as long as you stay in network, $5000 (or whatever your deductible is) plus any coinsurance is the total you're liable for in a year.

Posted: 21 Jan 2009 03:18 Post Subject:

I'm not sure this is a newer high deductible plan but it very well could be. I just switched to such a plan so I know very little about it. I was told, and this may be incorrect, that preventative check ups were paid at 100%. This is very well different for each plan. With health care insurance the plans are so different I'd always recommend speaking to the insurance company directly.

Posted: 21 Jan 2009 04:08 Post Subject: high deductible

On my policy, it says preventitive care $200.00 after coverage has been enforce for 12 consecutive months. Phsician's office visit $30.00 copay limited to 2 visits per calender year. I just didn't understand how my $5000.00 deductible is actually paid, meaning what goes towards meeting the $5000.00. That I will be paying out of pocket for any kind of treatment that I may have to have before my $5000.00 is paid.

Posted: 21 Jan 2009 04:49 Post Subject:

Anything you pay out of your pocket goes toward the $5000 deductible. If you have a low co-pay, yes... you or your doctor should always send each and every bill into the insurance company. Many doctors will call your carrier and confirm the benefits before your treated. If they can confirm that your carrier will pay all or a portion of the bill, some/many doctors will only charge you your portion and bill your carrier for the difference. But some doctors won't do this. So you'd need to pay the entire bill and send it to your carrier. The problem with this is that your carrier will only consider reasonable charges. If your doctor charges you $100 for an office visit, your carrier may only consider a portion of that if it's above Reasonable and Customary. This is why most will confirm the amount your carrier will consider and bill them for the amount they will pay. I'd not be too concerned about this.

Posted: 21 Jan 2009 10:16 Post Subject: high deductible

That's what I'm going to do, not worry so much about it. I was very lucky to even get any kind of major medical health insurance to begin with. It took forever to get approved by a health insurance company. My husband has high blood pressure, and either he was declined, or the rate was so high that it was impossible to pay the monthly payments. So, now that I have this one with a high $5000.00 deductible, maybe if I keep checking other companies, I will run across a health insurance policy with a lower deductible that I can afford. For now I will deal with what I have.
Thanks for all of your help.

Posted: 22 Jan 2009 09:02 Post Subject:

So, now that I have this one with a high $5000.00 deductible, maybe if I keep checking other companies, I will run across a health insurance policy with a lower deductible that I can afford. For now I will deal with what I have.

I wish you all all the luck!!

The high deductible plans also have a limit fixed for the yearly out-of-pocket expense for the insured, for the single individual it could be around $6,000 a year.

Depending upon the HDHP you may receive both on the network and out-of-the-network coverage. However, some policy may limit its benefits only to the inside the network physicians. therefore, make sure that you have read all the prints of the plan.

Posted: 22 Jan 2009 02:18 Post Subject:

You should definitely give your insurance card to your doctor. There are two reasons:

  • You may pay a lower price.
    Your insurance company will have a record of the visit and will credit the costs towards your deductible. (This is only true if the doctor is in network.)

Posted: 22 Jan 2009 02:19 Post Subject:


Posted: 22 Jan 2009 04:40 Post Subject: high deductible

Thank You for the information, Yes, I must stay with the doctors that are in network, Celtic will charge me an additional $1,500 deductible, coverage is only 60% instead of 80%. So, I will always double check this, before doing anything. It costs enough as it is. And now I know to always give them my insurance card. I just wasn't sure how it all works. I have probably read this policy a dozen times, and get more confused each time. Thats why I thought I should get advice and information from other people that certainly know a lot more about health insurance than myself.
Thank You,

Posted: 28 Jan 2009 05:37 Post Subject:

Also have the pharmacy file your prescriptions on your card, a lot of my clients forget to do this but it does count on a lot of these QHDP plans. Also will get you the pre negotiated drug price just like at the doctors office.

Posted: 31 Jan 2009 03:41 Post Subject:

Always carry your card just in case the doctors office needs the info on the card.

Posted: 01 Oct 2009 09:59 Post Subject: 5000 deduc plan

I also have a 5000.00 deduc plan, Can I add another plan that pays up to 5000.00 that can work along with this plan, that is have the small plan pay the first 5k and then the second one pay the rest?

Posted: 02 Oct 2009 09:16 Post Subject:

Hi Dana

Surely you can have 2 health insurance policies. One will act as your primary policy and the other as secondary. Normally such a co ordination works when the primary insurance pays up more than the secondary insurance. Then the balance amount will be picked up. But in case both the primary and the secondary plan pays up to the same amount then there will be no additional coverage. I would suggest you call your primary insurer and ask them how they would co ordinate such benefits.

Posted: 05 Oct 2009 12:24 Post Subject:

It is probably not in your best interests to have two policies. The additional cost of the second policy will probably outweigh the benefits.

Posted: 06 Oct 2009 04:52 Post Subject:

Surely you can have 2 health insurance policies. One will act as your primary policy and the other as secondary. Normally such a co ordination works when the primary insurance pays up more than the secondary insurance.

Be careful with this one. When comparing two group plans, you'll normally see a Coordination of Benefits provision. This would apply a primary and secondary payment concept when paying benefits.

When considering two individual plans, instead of a coordination of benefits provision you usually see contract language along the lines of an "other insurance in this insurer" or "other insurance with this insurer" provision. This basically pro-rates the payment of benefits based on the percentage of coverage each company has based on the total amount of coverage in force.

If this hooey makes any sense at all. :)

If one plan is a group plan and the other an individual plan, then things get weird. You'll have to look at the plans themselves to see how they look at things.

InsTeacher 8)

Posted: 06 Oct 2009 05:54 Post Subject:

Apart from the payment pro-rata, does it also segregate the benefit offers between 2 group plans? Otherwise, it seems to me as if the coordination of benefits prov. is all about payments.

Posted: 09 Oct 2009 03:56 Post Subject: High deductible health insurance

Yes, give your insurance card at the doctor's office. That way your insurance carrier will credit the costs toward your deductible.

home insurance comparison

Posted: 09 Oct 2009 05:45 Post Subject:

Always. This way the insurance company will know what amount to count towards your deductible and so long as you're in network - then you will get the renegotiated rate as well on services provided.

Posted: 22 Oct 2009 02:58 Post Subject:

The turnarounds on high deductible health insurance plans are in reference to the great benefits.

First of all, I have absolutely no idea what this means. Flowergirl...could you clarify for me?

Next: Steven wrote:

Apart from the payment pro-rata, does it also segregate the benefit offers between 2 group plans? Otherwise, it seems to me as if the coordination of benefits prov. is all about payments.

You're pretty much right. Coordination of Benefits (COB) provisions ONLY apply in group contracts and not to individual policies which have historically pro-rated benefits between two policies based on the percentage of coverage each carrier holds compared to the total amount of coverage in force.

As an example: Let's say that you have 2 individual major medical policies with different carriers. Policy #1 has annual limits of $1,000,000, and policy #2 has annual limits of $500,000. The total amount of coverage in force is $1,500,000. Company 1 has two-thirds of the total coverage in force, and company 2 has one-third of the total coverage in force. The insured has a claim, say, for $30,000 and we'll assume that both carriers cover the loss. Carrier 1 would pay $20,000 and carrier 2 would pay $10,000, less any applicable deductibles. Co-insurance provision are commonly waived as well (not always) as each company actually would save money by protating the benefits. If company 1 was the only insurer in play, and we assume a $1,000 deductible and 80/20 co-insurance, they would have to pay $23,300 ($30k-$1k deductible = $29k x 80% = $23,200). They would have to pay more if there was a low stop-loss in place as well. So, they save money. No problem-o.

I should also state that this gets weird when comparing different types of plans, like a PPO vs. an HMO. In these areas, you have to look at the policy itself to see how it handles these situations. As well, when you consider that PPOs and HMOs aren't even insurance plans, it gets pretty complicated at times.

COB provisions deal with situation in which you have more than one group plan that applies to your loss. Consider a husband, wife and 3 kids. Everyone is covered by group plans from both parents. So, they all have "dual coverage" so to speak. COB establishes the priority of payments in the event of a loss and determines which plan is primary and which is secondary, or excess. Adoption of this rule greatly simplified how benefits were paid; prior to this it was a mess, especially with kids. The COB rules have been adopted, to the best of my knowledge, in every state as it was a mandate that came out of D.C. about 15-20 years ago. I could be wrong on the "every state" thing as the individual states have rights to make their own insurance laws. Anyway...

COB rules:

1. Coverage as an employee is primary over coverage as a dependent. So, the hubby would submit a claim to his employer's group carrier as primary and then submit any balance billing to his wife's group carrier for their consideration. Wifey would do the opposite, of course.

2. Kids are covered under the "birthday rule." Whichever parent has the earliest birthday during the year is the primary provider. My birthday is May 15th and my wife's is May 2nd. Her group plan is primary for our kids. Actual age doesn't matter- it's month and day of birth only- year of birth doesn't matter. In the event they share the same birthday (which happens a lot more than I ever thought it would), the parent who's been in their plan the longest would be primary.

3. For split households, the birthday rule goes out the window for the kids. Normally, the custodial parent becomes primary at this point unless a court order dictates otherwise.

There's a bit more, but not much. Hope this enlightened anyone who's actually interested!

InsTeacher 8)

Posted: 05 Jun 2010 03:17 Post Subject: credit copays

did your doctors office ever call you back after filing the claim to tell you the copay didn't apply? you have a credit to use next time! is she filing the claim wrong or is the processing wrong why would my copay not apply why would they want to give it back?

Posted: 05 Jun 2010 06:06 Post Subject:

It's possible that certain services might not be subject to a copayment. Normally, one leaves a copayment each time services are rendered.

It's doubtful that the claim is being submitted incorrectly, but don't expect the physician's office manager to be knowledgeable in all forms of insurance. If a copay was left and the insurance company says no copay is due, then the physican owes a refund or a credit toward a future service.

Posted: 14 Sep 2011 11:30 Post Subject: High deductible

In July my work switched health insurance. Now we have a $2600 deductible out of pocket before the insurance will pick up anything. Well recently I had trouble with my heart and ended up in 2 ambulances, 3 hospitals, being lifeflighted to the third, and now my new heart doctor says I need surgery to correct the problem. What am I suppose to do? I can't afford to pay more than a couple dollars each week towards the deductible and the bills are piling up and my doctor wants this procedure done as soon as possible. I'm drowning and see no way to the surface.

Posted: 15 Sep 2011 04:42 Post Subject:

Beg, borrow, or steal (well, consider the first two at least), the $2600 from family or friends, your insurance should cover much of the additional expense, and you can negotiate payments with hospitals and doctors after the fact.

Maybe your employer, who provided the insurance plan, would be willing to advance you the money.

Posted: 14 Oct 2014 07:07 Post Subject: your deductible :anonymous1960

If the claims are processed, the deductible has already been applied, regardless if you paid it or not. Ins just process claims, they do not keep track of what you actually pay. If the claims that are processed have been applied to your deductible, then it will show in the ins system as applied. Call your ins company and ask them what you have met already. Go to a different innetwork doc/hospital for additional services, since you still owe the other providers

Posted: 28 Oct 2014 01:43 Post Subject:

Nice of you to supply an answer three years after the fact.

Posted: 20 Nov 2014 08:16 Post Subject:

It is an insurance plan with lower premiums and higher deductibles, it is different from traditional health plan. It depends upon your situation that you need to pay to the doctor or not.

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