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Stupid Questions About Stupid Health Care BS

I'm anonymous because I know these are stupid questions but I have not had to make decisions about health care for many years and I have forgotten what some of this shit means. 

1] If it says $0 after deductible ($5000) it means that you have to pay full price until you meet the deductible, right?

2] Okay, now what if it says $10 (primary care office visit) and nothing about before or after the deductible ($6300) means that you just pay the $10, right?

I really hate feeling stupid and this is seriously annoying me. 

Answer Question

Asked by Anonymous at 8:19 AM on Nov. 23, 2013 in Health

Answers (8)
  • Every state's website is different, so it's hard to say what you're seeing. It sounds accurate from how you're describing it - if the $10 is a co-pay you pay that for regular doctor visits. The deductible is what you pay before anything is covered, and what will vary from plan to plan is what counts towards your deductible. For example, your plan may cover physicals, but not any lab work done at the physical, so you pay $10 (or nothing) to the physical, but then have to pay for the lab work in full until you meet the deductible. Other plans might include the lab work with the physical, but not follow up lab work if one of those tests shows something wrong and they need more.

    Answer by NotPanicking at 9:33 AM on Nov. 23, 2013

  • 1) Basically yes. Now keep in mind I really don't know, and I'm going based off of the little info you have given. If a plan says the ded is $5000 and then your responsibility is $0 after ded, then yes, you pay up to the $5000, then the plan kicks in at 100%. Of course, there's probably always fine print, like exceptions and non-covered services. I always check for those.

    2) Again, basically yes. If it's a $10 copay, then the pcp office visit is just $10, but... that may or may not include all services done at that visit (i.e. lab, radiology, etc. and keep in mind something as simple as a strep test is considered lab work).

    The most important thing is that you research the hell out of each plan so that you don't have any shitty surprises when you use your insurance. If you are going thru the exchange, and your state has representatives (or guides as my state calls them) to talk to about the plans, then talk to them.

    Answer by anime_mom619 at 10:43 AM on Nov. 23, 2013

  • This is the most frustrating thing to me about this new healthcare thing. I verify insurance for a living, I know what to look for and what questions to ask. Most people don't.

    Answer by anime_mom619 at 10:45 AM on Nov. 23, 2013

  • Thanks ladies. I hate this stupid shit. I guess I will put it off until I can print (out of ink) the crap out and go over them with a fine tooth comb.

    At least I found out that all the plans are accept at the last doctor I went to.

    None of them seem to recognize my favorite pharmacy though, dammit. I don't want to go to somewhere like Walmart or CVS. I want my small town, privately owned drug store ... you know, the kind with a lunch counter and they know you by face and name.

    Comment by Anonymous (original poster) at 10:59 AM on Nov. 23, 2013

  • Call and ask the insurance company for clarification.... I'm sure you are not the only one who has asked this question!

    Answer by Crafty26 at 11:50 AM on Nov. 23, 2013

  • That is a ridiculous deductible.

    Answer by staciandababy at 1:23 PM on Nov. 23, 2013

  • Staci ... yes it is but we can't afford another bill and we can't afford the the fine, so I am picking the plans that cost me nothing a month (bronze) and they have really high deductibles.

    Comment by Anonymous (original poster) at 1:28 PM on Nov. 23, 2013

  • "That is a ridiculous deductible. "

    There are worse... some are as high as $10,000.

    Answer by anime_mom619 at 2:45 PM on Nov. 23, 2013

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