Help with high deductible health insurance

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PostPosted: Thu Oct 01, 2009 9:59 pm   Post subject: 5000 deduc plan  

I also have a 5000.00 deduc plan, Can I add another plan that pays up to 5000.00 that can work along with this plan, that is have the small plan pay the first 5k and then the second one pay the rest?


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PostPosted: Fri Oct 02, 2009 9:16 am   Post subject:   

Hi Dana



Surely you can have 2 health insurance policies. One will act as your primary policy and the other as secondary. Normally such a co ordination works when the primary insurance pays up more than the secondary insurance. Then the balance amount will be picked up. But in case both the primary and the secondary plan pays up to the same amount then there will be no additional coverage. I would suggest you call your primary insurer and ask them how they would co ordinate such benefits.



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PostPosted: Mon Oct 05, 2009 12:24 am   Post subject:   

It is probably not in your best interests to have two policies. The additional cost of the second policy will probably outweigh the benefits.



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PostPosted: Tue Oct 06, 2009 4:52 am   Post subject:   

Quote:
Surely you can have 2 health insurance policies. One will act as your primary policy and the other as secondary. Normally such a co ordination works when the primary insurance pays up more than the secondary insurance.




Be careful with this one. When comparing two group plans, you'll normally see a Coordination of Benefits provision. This would apply a primary and secondary payment concept when paying benefits.



When considering two individual plans, instead of a coordination of benefits provision you usually see contract language along the lines of an "other insurance in this insurer" or "other insurance with this insurer" provision. This basically pro-rates the payment of benefits based on the percentage of coverage each company has based on the total amount of coverage in force.



If this hooey makes any sense at all. Smile



If one plan is a group plan and the other an individual plan, then things get weird. You'll have to look at the plans themselves to see how they look at things.



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PostPosted: Tue Oct 06, 2009 5:54 am   Post subject:   

Apart from the payment pro-rata, does it also segregate the benefit offers between 2 group plans? Otherwise, it seems to me as if the coordination of benefits prov. is all about payments.

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PostPosted: Fri Oct 09, 2009 3:56 pm   Post subject: High deductible health insurance  

Yes, give your insurance card at the doctor's office. That way your insurance carrier will credit the costs toward your deductible.



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PostPosted: Fri Oct 09, 2009 5:45 pm   Post subject:   

Always. This way the insurance company will know what amount to count towards your deductible and so long as you're in network - then you will get the renegotiated rate as well on services provided.



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PostPosted: Wed Oct 21, 2009 8:41 pm   Post subject: High deductible health insurance  

The turnarounds on high deductible health insurance plans are in reference to the great benefits.



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PostPosted: Thu Oct 22, 2009 2:58 am   Post subject:   

Quote:
The turnarounds on high deductible health insurance plans are in reference to the great benefits.




First of all, I have absolutely no idea what this means. Flowergirl...could you clarify for me?



Next: Steven wrote:



Quote:
Apart from the payment pro-rata, does it also segregate the benefit offers between 2 group plans? Otherwise, it seems to me as if the coordination of benefits prov. is all about payments.




You're pretty much right. Coordination of Benefits (COB) provisions ONLY apply in group contracts and not to individual policies which have historically pro-rated benefits between two policies based on the percentage of coverage each carrier holds compared to the total amount of coverage in force.



As an example: Let's say that you have 2 individual major medical policies with different carriers. Policy #1 has annual limits of $1,000,000, and policy #2 has annual limits of $500,000. The total amount of coverage in force is $1,500,000. Company 1 has two-thirds of the total coverage in force, and company 2 has one-third of the total coverage in force. The insured has a claim, say, for $30,000 and we'll assume that both carriers cover the loss. Carrier 1 would pay $20,000 and carrier 2 would pay $10,000, less any applicable deductibles. Co-insurance provision are commonly waived as well (not always) as each company actually would save money by protating the benefits. If company 1 was the only insurer in play, and we assume a $1,000 deductible and 80/20 co-insurance, they would have to pay $23,300 ($30k-$1k deductible = $29k x 80% = $23,200). They would have to pay more if there was a low stop-loss in place as well. So, they save money. No problem-o.



I should also state that this gets weird when comparing different types of plans, like a PPO vs. an HMO. In these areas, you have to look at the policy itself to see how it handles these situations. As well, when you consider that PPOs and HMOs aren't even insurance plans, it gets pretty complicated at times.



COB provisions deal with situation in which you have more than one group plan that applies to your loss. Consider a husband, wife and 3 kids. Everyone is covered by group plans from both parents. So, they all have "dual coverage" so to speak. COB establishes the priority of payments in the event of a loss and determines which plan is primary and which is secondary, or excess. Adoption of this rule greatly simplified how benefits were paid; prior to this it was a mess, especially with kids. The COB rules have been adopted, to the best of my knowledge, in every state as it was a mandate that came out of D.C. about 15-20 years ago. I could be wrong on the "every state" thing as the individual states have rights to make their own insurance laws. Anyway...



COB rules:


1. Coverage as an employee is primary over coverage as a dependent. So, the hubby would submit a claim to his employer's group carrier as primary and then submit any balance billing to his wife's group carrier for their consideration. Wifey would do the opposite, of course.



2. Kids are covered under the "birthday rule." Whichever parent has the earliest birthday during the year is the primary provider. My birthday is May 15th and my wife's is May 2nd. Her group plan is primary for our kids. Actual age doesn't matter- it's month and day of birth only- year of birth doesn't matter. In the event they share the same birthday (which happens a lot more than I ever thought it would), the parent who's been in their plan the longest would be primary.



3. For split households, the birthday rule goes out the window for the kids. Normally, the custodial parent becomes primary at this point unless a court order dictates otherwise.



There's a bit more, but not much. Hope this enlightened anyone who's actually interested!



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PostPosted: Sat Jun 05, 2010 3:17 pm   Post subject: credit copays  

did your doctors office ever call you back after filing the claim to tell you the copay didn't apply? you have a credit to use next time! is she filing the claim wrong or is the ins.co processing wrong why would my copay not apply why would they want to give it back?


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PostPosted: Sat Jun 05, 2010 6:06 pm   Post subject:   

It's possible that certain services might not be subject to a copayment. Normally, one leaves a copayment each time services are rendered.



It's doubtful that the claim is being submitted incorrectly, but don't expect the physician's office manager to be knowledgeable in all forms of insurance. If a copay was left and the insurance company says no copay is due, then the physican owes a refund or a credit toward a future service.



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PostPosted: Wed Jun 09, 2010 11:01 am   Post subject:   

i think you don't have to pay it then.

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PostPosted: Wed Sep 14, 2011 11:30 pm   Post subject: High deductible  

In July my work switched health insurance. Now we have a $2600 deductible out of pocket before the insurance will pick up anything. Well recently I had trouble with my heart and ended up in 2 ambulances, 3 hospitals, being lifeflighted to the third, and now my new heart doctor says I need surgery to correct the problem. What am I suppose to do? I can't afford to pay more than a couple dollars each week towards the deductible and the bills are piling up and my doctor wants this procedure done as soon as possible. I'm drowning and see no way to the surface.


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PostPosted: Thu Sep 15, 2011 4:42 pm   Post subject:   

Beg, borrow, or steal (well, consider the first two at least), the $2600 from family or friends, your insurance should cover much of the additional expense, and you can negotiate payments with hospitals and doctors after the fact.



Maybe your employer, who provided the insurance plan, would be willing to advance you the money.



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PostPosted: Tue Oct 14, 2014 7:07 pm   Post subject: your deductible :anonymous1960  

If the claims are processed, the deductible has already been applied, regardless if you paid it or not. Ins just process claims, they do not keep track of what you actually pay. If the claims that are processed have been applied to your deductible, then it will show in the ins system as applied. Call your ins company and ask them what you have met already. Go to a different innetwork doc/hospital for additional services, since you still owe the other providers


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