Healthcare Language

[btq96r]

As a full time student, I can use student health services for most things, and actually really like the doctor there.  I do know I should probably get insurance for car accidents or the like.  Funny thing is, a "bronze" plan is cheaper than catastrophic insurance. 

 

I fully admit I'm dumb at all the talk about health plans.  Can somebody explain what this all means?  The plan has a deductible of $5,200 and an out of pocket maximum of $6,400.  Would any bill for hospital services cap at $6,400 then? 

 

Hospital services

Emergency room care

50% Coinsurance after deductible In-Network

50% Coinsurance after deductible Out-of-Network

Limits and Exclusions Apply

 

Inpatient doctor and surgical services

50% Coinsurance after deductible In-Network

50% Coinsurance after deductible Out-of-Network

Limits and Exclusions Apply

 

Inpatient hospital services (like a hospital stay)

50% Coinsurance after deductible In-Network

50% Coinsurance after deductible Out-of-Network

Limits and Exclusions Apply

Edited February 14, 2015 by btq96r

[ironsniper1]

i wish you luck i havent gotten insurance and dont want too

[NextExit]

Every plan is different with a lot of small print.  The days of $25 copays are over unless you have a Cadillac plan (which is like paying a second mortgage) Best to call your insurance provider and play 20 questions with them.  Also, do everything thru your PCP.  If you're out of network and need to see a Doctor, call yours for a referral.  It can lower your out of pocket expense. 

[btq96r]

Every plan is different with a lot of small print.  The days of $25 copays are over unless you have a Cadillac plan (which is like paying a second mortgage) Best to call your insurance provider and play 20 questions with them.  Also, do everything thru your PCP.  If you're out of network and need to see a Doctor, call yours for a referral.  It can lower your out of pocket expense. 

 

I'm looking through the Federal Exchange for a plan since being a college student with only a small on-campus job leaves me with no real options.  Playing 20 questions will have me on the phone with somebody reading from a script.  I really only need the emergency services and hospital coverage.  Everything else I'll just do with my doctor on campus.

[NextExit]

I'm looking through the Federal Exchange for a plan since being a college student with only a small on-campus job leaves me with no real options.  Playing 20 questions will have me on the phone with somebody reading from a script.  I really only need the emergency services and hospital coverage.  Everything else I'll just do with my doctor on campus.

 

Sorry, I just went thru this crap 2 weeks ago.  All I wanted to know was that I wasn't going to lose my home if I was gonna be laid up for a week or two in the hospital.  I went thru an independent agent rather than deal with the healthcare gov website.  Saved me quite a bit.

[btq96r]

Sorry, I just went thru this crap 2 weeks ago.  All I wanted to know was that I wasn't going to lose my home if I was gonna be laid up for a week or two in the hospital.  I went thru an independent agent rather than deal with the healthcare gov website.  Saved me quite a bit.

 

Can you post or PM me who you used?  I've been quoted at $150 a month for a bronze plan, based on my low income.  I looked through USAA first to see if any of there partners would work, and their lowest was $239 a month.

[NextExit]

PM sent

[felinesNfreedom]

 Check with  TRH, Tennessee rural health. You can go by a farm bureau office or check them out on line. We still use them even with my company now offering insurance. Before the ACA went into effect my monthly payment was 240.00, wife and kid, Now it's 360. 00. It's a PPO with a 25 dollar co pay, 200 for ER and 80/20 with a 1500 deductible ( that went up after the ACA too) Because of the way the organization is structured and the fact that they still put riders on insurance policies you will have to pay the penalty when the gubment figures everything out. I just finished my taxes and the insurance question just ask if you have it and where you got it, not if it qualifies. It might be pretty cheap for a young single guy. 

[Oh Shoot]

As a full time student, I can use student health services for most things, and actually really like the doctor there.  I do know I should probably get insurance for car accidents or the like.  Funny thing is, a "bronze" plan is cheaper than catastrophic insurance. 

 

I fully admit I'm dumb at all the talk about health plans.  Can somebody explain what this all means?  The plan has a deductible of $5,200 and an out of pocket maximum of $6,400.  Would any bill for hospital services cap at $6,400 then? 

 

Hospital services

Emergency room care

50% Coinsurance after deductible In-Network

50% Coinsurance after deductible Out-of-Network

Limits and Exclusions Apply

 

Inpatient doctor and surgical services

50% Coinsurance after deductible In-Network

50% Coinsurance after deductible Out-of-Network

Limits and Exclusions Apply

 

Inpatient hospital services (like a hospital stay)

50% Coinsurance after deductible In-Network

50% Coinsurance after deductible Out-of-Network

Limits and Exclusions Apply

 

Yep. Just means everything up to 5200 is all out of your pocket, half above that, and then insurance pays all of anything beyond your 6400. Note that is almost certainly per year though, and not "per disease".

 

Its a pretty standard "catastrophic" type plan, but of course sucks for normal health care if it doesn't have cheap co-pays for normal and specialist doctor visits. Probably has some sort of drug discount plan with it too, though.

 

- OS

Edited February 15, 2015 by Oh Shoot

[btq96r]

Yep. Just means everything up to 5200 is all out of your pocket, half above that, and then insurance pays all of anything beyond your 6400. Note that is almost certainly per year though, and not "per disease".

 

Its a pretty standard "catastrophic" type plan, but of course sucks for normal health care if it doesn't have cheap co-pays for normal and specialist doctor visits. Probably has some sort of drug discount plan with it too, though.

 

- OS

 

It's a '"regular" plan, not a catastrophic one from Blue Cross, Blue Shield of TN through healthcare.gov.  I just quoted the hospital stay stuff to get comments because that's all I plan to use it for unless I need to spend time with a urologist again.  No sense going through insurance and all the associated paperwork when all I have to do is make an appointment with MTSU Health Services for routine visits and what not.  It's really to make sure a hospital visit after a car crash doesn't bankrupt me.

 

I have enough in the rainy day fund to cover the max out of pocket, which was my biggest concern.   Thanks, brother.

[ironsniper1]

i dont now about the rest of you but im getting hammered by people tell me i NEED to get insurance and im sick of it, i dont want it but i dont want to have to pay a fine either its so stupid

[btq96r]

i dont now about the rest of you but im getting hammered by people tell me i NEED to get insurance and im sick of it, i dont want it but i dont want to have to pay a fine either its so stupid

 

The amount of the fine isn't what concerns me, it's a situation like getting into a car crash and being stuck with a hospital bill that puts me in the poor house after wiping out my savings and investments.  When I was working overseas, I was covered under the Defense Base Act by my contract.  Now that it's just me, myself and I, a bit of protection is needed.

Edited February 15, 2015 by btq96r

[btq96r]

Bumping this thread to share my tales of WTF...last Friday was my first experience dealing with the insurance process, and Judas Priest was it a clusterfawk. 

 

At the recommendation of my everyday doctor, I went to see a specialist because apparently having high blood pressure (meds control it) and a good bit of sleep issues isn't good for me.  Seems that my thinking I was good to go with random naps to make up for a 3-4 hour night of sleep in the week, and catching up on weekends would be fine isn't a valid course of action by medical actions.  Thus, it's off to see if I need to be checked for sleep apnea.

 

Now, I had a feeling I'd be paying for most if not all of the visit, but what kills me is I couldn't get any kind of estimate for what I'm about to be charged.  The lady at the office reception window who checked me in gave me the number of the billing department, and the billing department (not in our state, of course) said they had to wait until they got the codes from the office to put a number on it.  So, with all that, all I let happen was a visit with the doctor, more a consultation than anything else where he asked me some questions, did the standard push tests (does this hurt), yadda, yadda.  So, I'm hopeful that I don't get a huge bill once it goes through everything.  Apparently it's going direct to the insurance company, who will pass on every bit to me, unless it gets to my annual cap which would make me have that stroke I'm trying to avoid.

 

So, my question is this...is this kind of hidden fee thing common if you need to see specialists like that?  I kept getting the "we don't know what the doctor will do" line, but how can there not be a basic office visit fee if no special equipment comes out or the visit is kept to <30 min?

[R_Bert]

i dont now about the rest of you but im getting hammered by people tell me i NEED to get insurance and im sick of it, i dont want it but i dont want to have to pay a fine either its so stupid

I have insurance, and still get one call per day 5 days per week, and two emails per day -  7 days per week, from healthcare.gov.   It is absolutely insane.

 

Trying to get on the web site & the 1-800 line and turn it off has been futile. The damned phone system leaves a voice mail - and ends with "if you already have insurance, please ignore this message"......

Edited February 1, 2016 by R_Bert

[hipower]

I rear the day my wife retires and we have to go thru all this mess.

[Caster]

i dont now about the rest of you but im getting hammered by people tell me i NEED to get insurance and im sick of it, i dont want it but i dont want to have to pay a fine either its so stupid

I'm with you. Don't have insurance. Won't be getting any.

They wear me out trying to sell me some. When I'm in a decent mood, I enjoy going round and round with them.
"I only go to doctor when I can't get the bleeding to stop on my own."
If that doesn't get them, then I whip out ...
"Just cause ya'll are a bunch p-----s and have to see a physician when you stub your toe don't mean the rest of us do."
They usually hang up after that.

[Sam1]

Bumping this thread to share my tales of WTF...last Friday was my first experience dealing with the insurance process, and Judas Priest was it a clusterfawk. 

 

At the recommendation of my everyday doctor, I went to see a specialist because apparently having high blood pressure (meds control it) and a good bit of sleep issues isn't good for me.  Seems that my thinking I was good to go with random naps to make up for a 3-4 hour night of sleep in the week, and catching up on weekends would be fine isn't a valid course of action by medical actions.  Thus, it's off to see if I need to be checked for sleep apnea.

 

Now, I had a feeling I'd be paying for most if not all of the visit, but what kills me is I couldn't get any kind of estimate for what I'm about to be charged.  The lady at the office reception window who checked me in gave me the number of the billing department, and the billing department (not in our state, of course) said they had to wait until they got the codes from the office to put a number on it.  So, with all that, all I let happen was a visit with the doctor, more a consultation than anything else where he asked me some questions, did the standard push tests (does this hurt), yadda, yadda.  So, I'm hopeful that I don't get a huge bill once it goes through everything.  Apparently it's going direct to the insurance company, who will pass on every bit to me, unless it gets to my annual cap which would make me have that stroke I'm trying to avoid.

 

So, my question is this...is this kind of hidden fee thing common if you need to see specialists like that?  I kept getting the "we don't know what the doctor will do" line, but how can there not be a basic office visit fee if no special equipment comes out or the visit is kept to <30 min?

 

To answer your question - the basics are that you probably have an annual deductible of (let's use $1000 as a round number) $1000 for professional services (actual doctor labor fees), $1000 for hospital services (hospital stays and visits) and $1000 for medical equipment.  Or you could have a straight-up $3000 annual deductible where you pay $3000 of the charges no mater what they are before you insurance even starts to pay (or you would pay up to $1000 in each of the categories - same deal as a generic lump sum deductible).  That's your deductible.  They you have coinsurance which is pretty much the same damn thing as a copay (from our perspective), but they separate them into two different things so they can charge you two smaller amounts to make you feel better instead of charging you one larger fee.  Copays and coinsurance really hurt when you realize they don't necessarily count towards your deductible.  And the medical device coinsurance fees are normally high.  And copays/coinsurance don't necessarily count towards your annual deductible limit.

 

All of your costs are contingent on the schedule of the plan that the doctor signed on to.  Meaning if your doctor signs up to be a provider under Plan A and you are covered under Plan A, he can only charge you the set price for services that Plan A says he can.  But no one will ever tell you how much you will pay for which services, if you want to know before you go to the doctor, you have to ask them to submit a preapproval which can take days to weeks depending on what the service is.

 

Hope that explains the clusterf*** a little better.

Edited February 1, 2016 by Sam1

[dawgdoc]

If everyone would ask how much each visit or procedure cost, every single time, maybe things would change. Instead, many people are complacent because "insurance will cover it." Medical professionals get uncomfortable talking about money because then they might have to defend the value of their services.

If everyone had to pay the exact cost of care each visit, the I think the costs would drop substantially. If the doctor had to look a parent in the eye and say, "I can't fix your child unless you give me X dollars," they would quickly learn what people are willing and able to pay. It only takes a few people saying you are a greedy, money hungry jerk who doesn't care about children before it takes a toll.

[A.J. Holst]

If everyone would ask how much each visit or procedure cost, every single time, maybe things would change. Instead, many people are complacent because "insurance will cover it." Medical professionals get uncomfortable talking about money because then they might have to defend the value of their services.

If everyone had to pay the exact cost of care each visit, the I think the costs would drop substantially. If the doctor had to look a parent in the eye and say, "I can't fix your child unless you give me X dollars," they would quickly learn what people are willing and able to pay. It only takes a few people saying you are a greedy, money hungry jerk who doesn't care about children before it takes a toll.

Except for the shell game the insurance companies play for negotiated services...the doc bills for $400, agreed upon reimbursement is $100, your insurance company "saved" you 75%! Makes you feel good about your insurance carrier...

[peejman]

Yep. Just means everything up to 5200 is all out of your pocket, half above that, and then insurance pays all of anything beyond your 6400. Note that is almost certainly per year though, and not "per disease".

 

Its a pretty standard "catastrophic" type plan, but of course sucks for normal health care if it doesn't have cheap co-pays for normal and specialist doctor visits. Probably has some sort of drug discount plan with it too, though.

 

- OS

 

 

 

Agreed on the out-of-pocket expenses, per year.  Hope you don't have major problem on Dec 30th.  My sister had to have her appendix removed on Dec 30th.  Some of the bills came before Jan 1 and some after, so the deductible and out-of-pocket max limits both got double-dipped.  3 days either way and it would have cost half as much. 

 

I do give some legitimacy to the benefits of the "negotiated rates".  I don't know why they do it that way, but there are some benefits.  When I had hernia surgery, there was a line item that was basically "incidentals" - $8000.  The negotiated rate for that was something like $400.  So that tells me that had an uninsured person had that procedure, they'd owe the full $8000 while I only had to pay $400.  $7600 is several years worth of premiums.  Something to think about. 

[btq96r]

Hope that explains the clusterf*** a little better.

 

Pretty much my situation, except I have a $5,200 annual deductible across the board in-network, and the co-pay takes it up to $6,400 out of pocket.  But it was the most affordable plan month to month for me.  I'm not mad so much that I have to pay out of pocket for the (relatively) small stuff, it's that I can't get a straight answer from medical offices who are more compartmentalized than the CIA.

 

And we wonder why so many people are ready to embrace a single payer system and get rid of such a mess. 

[Sam1]

That was the plan from the start.

[Ugly]

No we are not ready for single payer. It doesn't work anywhere and it's certainly not gonna work here. Commie asswipes!!!!!!

This was the plan from the start and my vote is to have heads roll! This country has surely gone to crap, I mean a liberal wet dream quickly.

Miserable liberals will never be satisfied, never. Until they're cured! Edited February 1, 2016 by Ugly

[btq96r]

It doesn't work anywhere and it's certainly not gonna work here.

 

It works well enough in the United Kingdom.

[Ugly]

It works well enough in the United Kingdom.

In relation to better than nothing, yes. But why would you ruin potentially the best medical system for a large country? There are flaws for sure and I say all of them are caused by beuracracy.
Besides, if it were so good the smart people would sell it to us instead of deceiving us.