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Medical Insurance ??? Feel so stupid when it comes to choosing a policy

Posted by on Sep. 14, 2011 at 12:41 AM
  • 21 Replies

All my life I have had HMO through either my mom or my work, and for the last two years my son has had Medical while i have gone without. Anyways, I am finally in a position where my son will loose his medical because I make way too much. So I have to buy a policy and I am so at a lost. I am not going with an hmo because the cheapest hmo is $650 a month and I want to spend about half of that. But the PPO stuff is confusing me. If it says co-insured 40% after a $900 deductible, most out of pocket $7,800. Does that mean that let say I am in a car accident and my medical bills for hospital stay are $50,000. Do I pay $7,800 and they pay the rest or would I have to pay $900, plus 60% amount which would be $30,000? Or does it mean let say I just broke my arm and the price was $5,900 so I would pay $900 plus 60% of the rest which would be $3,000 (which is less than the most out of pocket?)

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by on Sep. 14, 2011 at 12:41 AM
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Replies (1-10):
snowpeasmom
by on Sep. 14, 2011 at 12:42 AM

I think I get that anything before $900 is mine but after is it 40/60 split for everything period or only 40/60 split up to most out of pocket and then 100% covered?

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series40
by on Sep. 14, 2011 at 12:44 AM

My deductible is 3,000. a month hun. THE BEST advice that I will give you is this. WHICH EVER insurance you USE CALL THEM frequently even if you think it is silly >> call them. I just called them Friday THANK GOD.... Make sure you go over everything with them all the time even before you go to appts.

mommyof11050307
by Ruby Member on Sep. 14, 2011 at 12:44 AM

The $900 is the deductible. After you reach that the insurance kicks in and you pay a percentage after the $900. My insurance is i have to pay $250 every year per person if i go to the ER, after hour clinics or hospital stays. After that $250 my insurance kicks in and its 100% covered. The $250 can be reached if I pay my co pays on scripts and drs visits.

snowpeasmom
by on Sep. 14, 2011 at 12:48 AM

The 40% co-pay after the deductible is confusing me. I get the deductible part its the 40% up to most out pocket I am confused about.

Quoting mommyof11050307:

The $900 is the deductible. After you reach that the insurance kicks in and you pay a percentage after the $900. My insurance is i have to pay $250 every year per person if i go to the ER, after hour clinics or hospital stays. After that $250 my insurance kicks in and its 100% covered. The $250 can be reached if I pay my co pays on scripts and drs visits.


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alwayskk
by on Sep. 14, 2011 at 12:48 AM

I think you will find that a PPO is way better than an HMO.

For most of the private insurance policies I've had, what they do is bill you against your deductible. What that means is that if you break your arm and the bill is five grand, you will pay the copay or the co insurance, and they deduct that amount from your deductible until your deductible is zero, then after that, you would just pay the copay or co insurance.

For some policies, you only pay the copay upfront, then they send you a bill for the co-insurance.

Either way, before you buy the policy, you should call and talk to them and ask because each company/policy is different.

alwayskk
by on Sep. 14, 2011 at 12:50 AM


Quoting series40:

My deductible is 3,000. a month hun. THE BEST advice that I will give you is this. WHICH EVER insurance you USE CALL THEM frequently even if you think it is silly >> call them. I just called them Friday THANK GOD.... Make sure you go over everything with them all the time even before you go to appts.

You have a monthly deductible? Or do you mean your monthly premium?

snowpeasmom
by on Sep. 14, 2011 at 12:52 AM
Quoting alwayskk:

I think you will find that a PPO is way better than an HMO.

For most of the private insurance policies I've had, what they do is bill you against your deductible. What that means is that if you break your arm and the bill is five grand, you will pay the copay or the co insurance, and they deduct that amount from your deductible until your deductible is zero, then after that, you would just pay the copay or co insurance.

For some policies, you only pay the copay upfront, then they send you a bill for the co-insurance.

Either way, before you buy the policy, you should call and talk to them and ask because each company/policy is different.

Thanks with hmo its seems that I just go and pay $20 no matter why I was there. Of course my company or mom paid the premiums.

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yabbadabba07
by on Sep. 14, 2011 at 12:54 AM

Okay so if you were in a car accident you would pay the 900$ deductible and 7800$ and your insurance would cover the rest.

If you broke your arm you would pay the 900$ and 3000$ and insurance would cover the rest.

Those scenarios are assuming that that is the first time you have used the insurance and haven't previously paid into the 900$ deductible and such. Insurance companies make it confusing on purpose so people won't ask questions and will just pay what they tell them to.

series40
by on Sep. 14, 2011 at 12:55 AM

lol, I see what I did... My husband pays 200.oo per week , my deductible is 3,000 per calender yr.

Quoting alwayskk:

 

Quoting series40:

My deductible is 3,000. a month hun. THE BEST advice that I will give you is this. WHICH EVER insurance you USE CALL THEM frequently even if you think it is silly >> call them. I just called them Friday THANK GOD.... Make sure you go over everything with them all the time even before you go to appts.

You have a monthly deductible? Or do you mean your monthly premium?


yabbadabba07
by on Sep. 14, 2011 at 12:55 AM

Oh and after you paid all that you would be 100% covered for the rest of the period for other doctor/er visits.

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