 Posted: Fri May 21, 2010 9:16 am Post subject: |
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| Quote: | | dermatological procedures |
If these are strictly "cosmetic" and not medically-necessary, they may not be covered at all.
| Quote: | | I think the way im understanding how the deductible is met is my insurance pays 70% of the claim and i pay 30% and that 30% will go towards my $500 deductible. And once that $500 Deductible is met then insurance will cover 100% of my claims as long as they're approved through their review board. |
Sorry, but you do not understand this correctly.
Deductibles are normally applied to claims before any coinsurance is payable. Coinsurance is the 70/30 split you mention between the PPO and you. Copays (the $30 event) do not count toward the deductible, but some policies limit copays to an annual maximum out of pocket amount.
So here's an example: You have a $500 deductible, 70/30 coinsurance and $7500 maximum out of pocket expense (including copays). You suffer a covered medical event. Your total bill comes to $3500.
The math looks like this:
Total covered expenses = $3500
Less deductible = $ 500
Amount subject to coins = $3000
Insurer pays 70% = $2100
You pay 30% = $ 900
Copays are in addition
Only when your total out of pocket expense exceeds $7500 does the PPO cover 100% of the expenses.
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MaxHerr
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