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 Posted: Mon Mar 16, 2009 4:52 pm Post subject: What part of hospital stay will be direct billed by Dr.s? |
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I am thinking of changing from a straight hospitalization plan that does NOT cover direct-billed Dr. charges to a complete coverage plan with a $10k deductible. The new plan would be $100 less/month. Is going with the deductible worth it?
My union plan covers my Dr. visits only, no hospitalization.
Thanks for your help -
Harry
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Harry
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| Posted: Mon Mar 16, 2009 10:40 pm Post subject: |
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| Wow, that is a big deductable, you will sure be paying quite a bit, have you done your research on this? My employer offers four different plans, I think I would keep the insurance with the smaller deductible, they cover more for you, medical insurance is really nothing to be shopping for the bargain plan, if you have something that comes up that is major you will have to come up with that large amount of money. |
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goodnatured
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| Posted: Tue Mar 17, 2009 12:41 am Post subject: |
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| If you can afford a 10,000 deductible, then the $100 savings each month shouldn't be of large concern. However, if your motive for switching is to gain hospitalization coverage, then there are other options as well. If you can give us a little more information about the current policy that you have, we may be able to give you better advice. You said that it covers doctors' visits, but what about surgical procedures...x-rays...emergency room coverage...etc? If you don't feel like posting it, you can also send me a message and I'll see if I can give you some info... |
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ChrisBantly
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| Posted: Tue Mar 17, 2009 1:11 am Post subject: Hospitalization coverage |
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I am a free-lance musician. I work enough to get "Plan B" through my union, which covers doctor's visits, plus diagnostic, etc. i.e. a few years ago when I had a kidney stone, all of my visits, plus X-rays, IVP, etc. were covered though that plan. When I went to the ER with kidney stone pain, everything was covered through the Hospitalization coverage I pay for myself.
Having these two independent plans has worked OK up until now. But as my wife and I get older, I worry about long hospital stays and illnesses. My current Hospitalization plan specifically excludes "professional services of the surgeons or anesthesiologists unless they are employees of the hospital and their services are included in the hospital's charges." The coverage seems to include most everything else.
What else can fall through the cracks of these two complementary plans? Could it add up to MORE than the $10k deductible? Someone told me recently that a "friend" needed an appendectomy and ended up with a bill of $70k (!). This may or may not be apocryphal, but what portion of that might be directly billed by the doctors and thus NOT be covered under my current plan?
(The other thing is that the plan with the $10k deductible has a $5 million cap . . . . just noticed that . . . . )
Any ideas are greatly appreciated. Thanks!
Harry
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Harry
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| Posted: Tue Mar 17, 2009 1:17 am Post subject: P.S. |
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BTW, the plan I am looking at is through Fractured Atlas. The deductible turned me off right away, too, at first, but I am convinced we could end up owing a butt-load of $$$ either way if we have to endure even a medium-length stay.
My wife and I are both 41
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Harry
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| Posted: Tue Mar 17, 2009 4:46 am Post subject: |
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Lets say you go into the hospital for a surgery (broken leg) and have a 4 day stay in the hospital. You are going to get a bill from the hospital for the room, surgical room, x-rays taken, medical supplies, sometimes drugs. You will get the surgeons bill. You will get the radiologist bill (reading x-rays). You will sometimes get an anesthesia bill. How it is all covered really depends on the policy/policies you have.
Now if you have to go just to the ER (hurt leg not broken), you will get the facility bill, ER doctor’s bill, and radiologist bill.
A month stay in a hospital for say a serious heart problem with surgery, I’ve seen the facility bill be more then 250K.
The deductible is high, but it wouldn’t take long for facility charges to add up quick.
I wouldn’t worry about the 5 Million cap, as it would take a long time to reach that if at all. Said another way, if you reach the 5 million you have a lot bigger problems then medical bills. |
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Dasfuk
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| Posted: Tue Mar 17, 2009 9:36 am Post subject: |
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Harry!!
i have some other option for you.Get an insurance which covers even if you are getting treated from any international hospital.(in any other country)
Now when you are worrying about the cost involved due to the old ages, if for any specific surgery if you get it done from countries like India you save almost 50 % on the cost with all the modern facilities for treatment.
One need not worry about the quality of the treatment."Medical Tourism" is really a nice concept.If you can give a thought about it, even your insurance company will also not mind it as they will be saving a lot more........
give a try for comparison. 
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amit
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| Posted: Wed Mar 18, 2009 6:13 pm Post subject: Yes, but . . . |
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I know how things will be billed and what will or will not be covered under each plan. My Question is: Will the charges directly from the doctors at the hospital that ARE NOT COVERED ON MY CURRENT PLAN be more than the $10k deductible on the plan I am now considering? In other words, On which plan would I end up paying more out of my pocket?
In your example, DasFuk, you mention facility charges could be $250k. What would the corresponding Dr. charges be for a stay like that? If those charges end up being more than $10k, then perhaps the plan with the deductible would be a better option?
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Harry
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| Posted: Wed Mar 18, 2009 7:55 pm Post subject: |
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| What I typically saw was that a person would get the facility bill, the surgeon’s bill which could be over 10K depending on the surgery and I am not sure how your policy reads for surgeon bills. The doctors that usually check in during your stay are staff physicians and considered on the facility bill. Typically if a surgeon (lets say he is not on staff at the hospital due to specialty) checks in on you, his charges would (should) be considered under the global surgical fee. The same should be true when you have a x month check up following the surgery. So no, I did not typically see individual doctor bills for an extended stay that would exceed 10K. But every facility/medical provider bills in their own manner. |
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Dasfuk
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| Posted: Wed Mar 18, 2009 10:15 pm Post subject: |
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Thank you! That helps 
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Harry
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| Posted: Sat Mar 21, 2009 4:05 pm Post subject: |
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hey dasfuk this is really a nice information alltogether. bon vouge!!
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