Co-insurance, co-pays and deductibles explained

re: Co-insurance, co-pays and deductibles explained

ELLIE M. — Sat, 22 Aug 2009 23:12:01 GMT

WHY, IF I PAY CASH IS THE COST 85.00. IF I USE MY INSURANCE THEY CHARGE 150.00 PLUS 15.00 CO PAY MENT AND REQUIRE I RETURN EVERY MONTH TO SEE THE DR. FOR APPROXAMATLY ONE AND 1/2 MINUTES.MOST ANY OTHER DR. WRITES 3 REFILLS THEN I RETURN TO TO SEE HIM.HE'S GOT ME IN A CORNER BECAUSE OF THE LENGTH OF MY TREATMENT. I CANNOT GO WITHOUT BECAUSE HE KNOWS I,LL GET REALLY SICK.I CAN,T LEAVE THE AREA BECAUSE HE WONT SEE TO IT I HAVE ENOUGH MEDS OR CAN GET A REFILL

re: Co-insurance, co-pays and deductibles explained

Louise G — Tue, 11 Aug 2009 17:34:40 GMT

Our family has two insurance plans from the same insurance company. Recently we had to go out of network for a family member's care. Each plan says they cover 50%. The EOB I received from the secondary insurer paid nothing. The explanation I received from the customer service agent was that the primary insurance paid 50% of the providers fee. The other 50% is now Co-insurance that I must pay. If there was any additonal fees remaining then the secondary would pay.

The insurance company told me secondary is not supplemental insurance and does not cover the difference between the fees charged and what the primary pays.

The reality is that our secondary insurance is of NO benefit, causes much hassle and we are still out of pocket. Our family member will need weekly treatment that will never be covered by the secondary insurer according to their rules.

Our secondary policy is really the third party and we the insured member are secondary. We get to pay for coverage that does not exist, plus the 50%, plus deductibles.

It is time to put insurance companies with this type of creative accounting out of business. I would much rather have a single payer universal health care plan with clear, easy, transparent rules administered by medical professionals than all this expensive,subterfuge dictated by greedy uncaring profit motivated insurance companies.

re: Co-insurance, co-pays and deductibles explained

Les Stark — Tue, 07 Jul 2009 21:42:12 GMT

Car dealers are all crooks and slime balls.

re: Co-insurance, co-pays and deductibles explained

Dr. Tom — Sat, 04 Jul 2009 03:31:57 GMT

Often it is better if you see a provider that is OUT OF NETWORK. Recent example from my clinic today...prospective patient comes in to interview me. At some point, the question of cost always comes up. In his case, I am not a PPO provider for his "ABC" insurance company. His in-network benefits were a $25 copay per visit (and most likely ABC would pay me peanuts had I signed their contract toward the $55 billed on average...nowhere near the $30 difference because preferred providers are only preferred because they agree to work for almost half).

Out of network ("OON"), today's patient has a $500 deductible to cover for a condition that will require multiple office visits to optimally treat versus only symptom relief (think putting out fire vs. only turning off alarm). After that he only pays 40%. That's an avg of $22/visit and I get paid my full fees.

Some caveats for health care consumers: This OON would not be beneficial (cost-wise) for isolated, limited conditions because the deductible is 100% your $$, not ABC's $$. Your analysis will have to consider what is entailed in a complete treatment plan, what your deductible is and what your co-insurance is.

Case #2: I'm OON with "Susie Q's" insurance company. She continually asks-- are you getting on my XYZ network. "We've applied, Susie... Today's co-insurance of 10% is going to be $5.50 please (deductible has been met)." (REPEAT THIS FOR SEVERAL VISITS). Are you on my network yet? "Yes, we got the credential letter today. Today, your responsibility is $30."

"What! What happened to $5.50?" Susie's co-insurance was $5.50; her co-pay was $30 and that's all I collected (XYZ re-imbursed nothing else). In the last four years of being "preferred" with XYZ my reimbursement rates for the same services has decreased while patients' premiums stay the same or increase for the same policy. The USA has no health care crisis outside of poor lifestyle choice we're too stubborn to change; we have a health insurance crisis, and this is an example of how insurance companies are part of the problem!