what does 70% after deductible mean?

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PostPosted: Wed Oct 03, 2012 8:30 am   Post subject: what does 70% after deductible mean?  

In the plan that I'm looking at, it says "$30 copay for 3 visits, then plan pays 70% after deductible". Does that mean that I will have to pay the full doctor's office price for visit 4+ until I have paid all of my deductible -- then after I have paid all of my deductible of say $3000, then the insurance company will pay 70% of doctor visit costs?

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PostPosted: Wed Oct 03, 2012 10:58 am   Post subject:   

This is a health insurance question, not an auto insurance question.



Having said that, this is an unusual description of a health insurance benefit. But if accurately stated, it would mean what you have asked. Three visits at $30 each, plus 100% of the cost of future visits until the deductible was satisfied, then the insurance company would pay 70% of future expenses for the rest of the year.



If you can scan and email your contract or summary of benefits / outline of coverage to me, I may be able to give you a better answer.



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PostPosted: Mon Feb 11, 2013 8:31 pm   Post subject: deductible  

I have a medical insurance plan that pays 70% after the deductible of 8000.00 has been met...can you explain what that means? We never meet our deductible but it seems that . My husband needs a procedure that is covered only every 10 years, but the Dr. wanted him to do this procedure again this year, he had it done last year. Deemed it medically necessary. But the insurance says it will cover 70% after the deductible..I am so confused.


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PostPosted: Mon Feb 11, 2013 11:40 pm   Post subject:   

The deductible is the amount of money you need to pay toward your annual medical expenses BEFORE the insurance company begins to pay its 70% share of remaining expenses. Your policy may also include a "stop loss" provision that determines the total amount of out-of-pocket expenses you can incur in one year.



You have to read the "stop loss" provision carefully because it may or may not include the deductible.



$8000 is a very high deductible, and almost sounds like the stop loss, not the deductible. But if it is the deductible, that should translate into fairly low premiums because few people incur that much in the way of medical expenses each year. Those who do usually suffer some event that leads to a hospitalization, possibly including surgery or other therapeutic treatments. But the average person in their working years, sees the doctor a couple of times a year, maybe a trip or two to the ER or Urgent Care center for something relatively minor.



Even children, and adult women, who may see their physician several times each year, are unlikely to rack up $8,000 in medical expenses.



If your husband's insurance is group coverage, Obamacare may have already eliminated the "every ten years" restriction. If not, it will certainly be gone after January 1, 2014, when all annual and lifetime benefit restrictions in all health plans are eliminated. The words "medically necessary" should, even today, however, lift any restrictions on any procedure or treatment.



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PostPosted: Tue Feb 12, 2013 11:54 am   Post subject:   

‘After-deductible’ means that you pay something first and then the insurer allows you reduced-cost, free or co-pay services and drugs. In your case the ‘pay something first’ is $8000 dollars. Wonder what made you choose so high a deductible! Must be a HDHP?

Your medical expenses must not have crossed the 8000 limit. Anything beyond that and the insurer will pay 70% of the excess costs.


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PostPosted: Tue Feb 12, 2013 4:31 pm   Post subject:   

Quote:
Must be a HDHP?


Not possible!



The maximum permissible "self-only" TOTAL OUT OF POCKET EXPENSE (including all deductibles and copays, or coinsurance) is only $6250 in 2013. The maximum "self-only" deductible is $1250.


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