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New health insurance..... So confused..... HELP!!!

My hubbys new insurance through his job kicks in on April 3rd and they sent us all the info via E mail and I am so confused, we have never had insurancce before and not to sound totally stupid but when they talk deductables and such I am so mixed up and what exactly a deductable means... I keep reading and making myself more confused....

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Asked by Anonymous at 1:51 PM on Mar. 3, 2011 in Money & Work

Answers (5)
  • Contact the Human Resource person at your husband's place of employment. They will be able to answer all your questions. Or you could call the providers customer service number direct.

    Answer by meooma at 1:55 PM on Mar. 3, 2011

  • a co-pay is the amount you pay when you go to the Dr. A deductibel is the amount you have to cover before the insurance kicks in for non-office vbisit charges. (at least in my plan) Example: kid breaks a bone. You go to the doctor $20 for the office visit, but if the Dr. charges $100 the insurance pays $80 after you paid the $20 at the door. But then if there are x-ray charges. That you have to cover up to the limit of your deductible. Maybe $500. So if the x-rays are $80, you pay the x-rays. Now if he needs a CAT SCAN that might be charged at $2000. You pay the first $500 and the insurance pays the $1500. (except they never pay full price.) But after you pay the deductible for the year (usually per person) the insurance covers the rest, but you still have to pay the co-pay; The system is designed to keep you from running to the doctor for every little thing, but make sure that you can afford to go when you need to

    Answer by LoveMyDog at 2:28 PM on Mar. 3, 2011

  • If you have any specific questions, I can probably answer them. A deductible is the amount you have to pay out of pocket, before your insurance pays out any money. Depending on the carrier and your specific plan, You deductible may apply to everything, or may exclude things like well child visits, visits to your primary care physician and or ER visits for an accidental injury.

    I would call the insurance company and ask them questions until you have an understanding of your policy.

    Answer by twin_mommy at 2:29 PM on Mar. 3, 2011

  • A co-pay is the amount you pay when you go to the doctor, usually up front at the visit (around $20 or $30 for most offices or a little more for a specialist).
    The deductible is the amount you have to pay before the insurance starts paying their part. Think of it like a car insurance deductible. If your car insurance deductible is $500 and you have an accident, you are responsible for the $500 first, THEN the insurance will kick in. For health insurance, it's the same way. For example, if you have a $600 deductible, you have to come up with $600 first, then the insurance will start covering their part. If you just have a few office visits, then it'll take you awhile to get to $600. But if you have a big expense (like an x-ray or MRI), you'll get to $600 pretty quickly.
    Once you meet your deductible, then the insurance will start covering a percentage of your bill. A lot of insurance is 80/20 or 90/10. This means(cont

    Answer by SherriPie at 10:24 PM on Mar. 3, 2011

  • If your insurance is 80/20 for example, then your insurance will cover 80% of the negotiated cost (the insurance "negotiates" a price with the doctor first) and you pay for 20% of the cost. So if you get an MRI or Xray and the negotiated/discounted cost is $2000, you are responsible for 20% of that amount or $400 (IF you've met your deductible first). If you haven't met your deductible for the year, then you have to pay your deductible first before insurance will cover the 80%. Example:
    If you haven't met your deductible: Kid breaks a bone, you go to ER. Total cost is $2000 for everything including xrays. You pay your ER co-pay (around $75 for example). THEN, you pay your deductible ($500 for example). Then insurance kicks in paying 80% (or $1600).
    If you have met deductible, Total cost $2000, you pay your percentage ($400 for example if it's 20%) and insurance pays the rest.

    Answer by SherriPie at 10:29 PM on Mar. 3, 2011

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