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| *Ostroff, Fair and Company>>>Insurance |
What does deductible mean when you try to get health insurance? |
it says plan type : PPO. Deductible. 2,500. Coinsurance 20%. Office Visit. $30. Monthly Premium. $60..what does all that mean?? With insurance, a deductible is what you will pay should something happen, the remainder being paid by insurance. If a procedure costs less than the deductible, then you're paying the entire cost yourself. You pay 20% of what your bills are, that's your co-insurance. But, you can only pay a maximum of $2500 out of pocket for those costs. That's your deductible. deductible is what you have to pay out of your pocket before your insurance will pay anything. Under this plan, you would need to spend $2500 in medical bills in 2007 before the insurance pays a penny. Once you reach $2500 then you pay $30 for each office visit (and the insurance pays the rest) and you pay 20% of each non-office visit (emergency room, for example) and the insurance pays the rest. Monthly premium is the amount you pay each month to have the insurance. The deductible for your health insurance is the amount that you need to pay at the time the services(ie:doctor visit) is done & the remainder is paid by the insurance carrier. Deductible is the amount of doctor or hospital or lab charges that has to be paid by you before the insurance picks up any of the tab. Coinsurance is the percentage of the payable amount (meaning not what is billed to the insurance, but what the contract between the provider and the insurance says the insurance will pay.) that is your portion to pay. It's not always the same dollar amount. Office visit - this is your copay. It is a predermined dollar amount that is paid by you every time you see the doctor - at the time of service. That's the big difference between this and the deductible and co-insurance - NEVER pay those up front. Wait until your insurance is billed, and the insurance will tell the provider (in writing, on an explanation of benefits) exactly what to charge you. Some plans have a copay for office visits and a deductible for only hospital or lab charges or office procedures aside from the straight office visit. (i.e. if the doctor or his staff draws blood, or takes a urine sample or swabs your throat for a strep test.) Other plans have the deductible first, then the copay and coinsurance. Be sure to check exactly what your deductible is for first to avoid any nasty surprises. (My plan has a $3000 hospital deductible - which is for anything done at a hospital - whether it's a test or a stay.) Premium - this is your charge to buy the insurance coverage. $60 a month is VERY good! (I pay almost $400 a month) Hope this helps. I'm a medical biller. The deductible or excess is the amount you have to pay yourself, and the amount in excess of the deductible is the responsibility of your insurer. On occasion, a franchise may be applied, i.e. you are responsible for costs up to a certain amount, but if the bill exceeds the franchise, then the insurer pays it all. |
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