More Health Insurance Questions

[NoExcuses]

I feel ya girl. <img src="i/expressions/face-icon-small-smile.gif" border="0">

Call up the plan (or talk to HR) if you want to verify what the out of pocket max refers to.

For me, my out of pocket max applies to my in-network co-pays (for hospital visits, doc visits, x-rays, labs combined). Then I have a seperate out of pocket max for out of network stuff.

It's a lot to deal with for sure <img src="i/expressions/face-icon-small-smile.gif" border="0"> I totaly understand. <img src="i/expressions/face-icon-small-smile.gif" border="0"> <img src="i/expressions/face-icon-small-smile.gif" border="0"> <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[blondelawyer]

Generally the deductible is the amount you pay before you are covered at all, so in your case, say the first thing you have is a hospital visit. You will pay the first $500, and then 10% of the rest. You will continue to pay the 10% until you have paid a total of $2000 ($500 for the deductible, plus the $1500 out of pocket max).

I second Amy's suggestions of calling up the plan administrator. They should be able to give you the numbers and tell you what falls under what limit, etc.

Good luck!

 

[blondelawyer]

Generally the deductible is the amount you pay before you are covered at all, so in your case, say the first thing you have is a hospital visit. You will pay the first $500, and then 10% of the rest. You will continue to pay the 10% until you have paid a total of $2000 ($500 for the deductible, plus the $1500 out of pocket max).

I second Amy's suggestions of calling up the plan administrator. They should be able to give you the numbers and tell you what falls under what limit, etc.

Good luck!

 

[blondelawyer]

Generally the deductible is the amount you pay before you are covered at all, so in your case, say the first thing you have is a hospital visit. You will pay the first $500, and then 10% of the rest. You will continue to pay the 10% until you have paid a total of $2000 ($500 for the deductible, plus the $1500 out of pocket max).

I second Amy's suggestions of calling up the plan administrator. They should be able to give you the numbers and tell you what falls under what limit, etc.

Good luck!

 

[JennifersHope]

Thanks I think I am going to try to call the plan directly.. I am a little nervous about sending red flags off to my new job..


I did call Beth ( the CF lawyer today) and I am waiting for her to get back to me as to what is the best way to handle my pre emplyment screening.

 

[JennifersHope]

Thanks I think I am going to try to call the plan directly.. I am a little nervous about sending red flags off to my new job..


I did call Beth ( the CF lawyer today) and I am waiting for her to get back to me as to what is the best way to handle my pre emplyment screening.

 

[JennifersHope]

Thanks I think I am going to try to call the plan directly.. I am a little nervous about sending red flags off to my new job..


I did call Beth ( the CF lawyer today) and I am waiting for her to get back to me as to what is the best way to handle my pre emplyment screening.

 

[LouLou]

be aware that there's usually a seperate out of pocket max for medical expenses (hospitalizations, lab, doctor's visits) and an out of pocket max for prescriptions. I have been on HMOs and PPOs. In general I would prefer a PPO but I've had good luck with my cf centers taking the HMO plan I'm on. I am currently on an HMO and before that plan I was on an HMO too. You do have to stay on top of getting referrels before you get care anywhere but other than that I haven't had a problem. You can inquire with doctors to see if they take the HMO to help you in the decision as well. If there weren't a cost savings to take the HMO or it wasn't the only option (my current situation) than I would choose PPO because you are more in control and doctor's are paid more fairly. It makes me irrate to know and think about how doctor's are comprimised payment wise and might alter our care because of this...for example less sputum cultures because the pre-negotiated rate is so low, etc.

 

[LouLou]

be aware that there's usually a seperate out of pocket max for medical expenses (hospitalizations, lab, doctor's visits) and an out of pocket max for prescriptions. I have been on HMOs and PPOs. In general I would prefer a PPO but I've had good luck with my cf centers taking the HMO plan I'm on. I am currently on an HMO and before that plan I was on an HMO too. You do have to stay on top of getting referrels before you get care anywhere but other than that I haven't had a problem. You can inquire with doctors to see if they take the HMO to help you in the decision as well. If there weren't a cost savings to take the HMO or it wasn't the only option (my current situation) than I would choose PPO because you are more in control and doctor's are paid more fairly. It makes me irrate to know and think about how doctor's are comprimised payment wise and might alter our care because of this...for example less sputum cultures because the pre-negotiated rate is so low, etc.

 

[LouLou]

be aware that there's usually a seperate out of pocket max for medical expenses (hospitalizations, lab, doctor's visits) and an out of pocket max for prescriptions. I have been on HMOs and PPOs. In general I would prefer a PPO but I've had good luck with my cf centers taking the HMO plan I'm on. I am currently on an HMO and before that plan I was on an HMO too. You do have to stay on top of getting referrels before you get care anywhere but other than that I haven't had a problem. You can inquire with doctors to see if they take the HMO to help you in the decision as well. If there weren't a cost savings to take the HMO or it wasn't the only option (my current situation) than I would choose PPO because you are more in control and doctor's are paid more fairly. It makes me irrate to know and think about how doctor's are comprimised payment wise and might alter our care because of this...for example less sputum cultures because the pre-negotiated rate is so low, etc.

 

[julie]

HMO's are just a pain in the butt because you have to have a referral for EVERYTHING! However, if you've got a good primary care doctor and a good CF doctor, it shouldn't be a problem HMO's aren't the ins. choice for most because most prefer freedom and not have to jump through all the red tape to get seen by a specialist.

I'd look into the HMO plan and see "who" can send referrals. Only your PCM (Primary care manager), or also any specialist that you are referred to. That's an important question to know the answer to.

 

[julie]

HMO's are just a pain in the butt because you have to have a referral for EVERYTHING! However, if you've got a good primary care doctor and a good CF doctor, it shouldn't be a problem HMO's aren't the ins. choice for most because most prefer freedom and not have to jump through all the red tape to get seen by a specialist.

I'd look into the HMO plan and see "who" can send referrals. Only your PCM (Primary care manager), or also any specialist that you are referred to. That's an important question to know the answer to.

 

[julie]

HMO's are just a pain in the butt because you have to have a referral for EVERYTHING! However, if you've got a good primary care doctor and a good CF doctor, it shouldn't be a problem HMO's aren't the ins. choice for most because most prefer freedom and not have to jump through all the red tape to get seen by a specialist.

I'd look into the HMO plan and see "who" can send referrals. Only your PCM (Primary care manager), or also any specialist that you are referred to. That's an important question to know the answer to.

 

[gsplover]

Julie hit the nail on the head, a good Primary Care Physician and CF doc is key. I have always screened my PPC before choosing to see if they are going to make me jump through hopes to do what I need to do for my health. If they do, I don't choose them as my PPC.

 

[gsplover]

Julie hit the nail on the head, a good Primary Care Physician and CF doc is key. I have always screened my PPC before choosing to see if they are going to make me jump through hopes to do what I need to do for my health. If they do, I don't choose them as my PPC.

 

[gsplover]

Julie hit the nail on the head, a good Primary Care Physician and CF doc is key. I have always screened my PPC before choosing to see if they are going to make me jump through hopes to do what I need to do for my health. If they do, I don't choose them as my PPC.

 

[blondelawyer]

One other thing that I remembered from our HMO experience--when my husband goes to the clinic, he sometimes sees a different doctor (he has one main one that he sees, but sometimes she isn't there or for some other reason he sees another one of the CF docs). This caused a big problem with our insurance because the referral couldn't be made to the "Clinic" as a whole and had to be to the individual doctor. So...that is something to just be aware of (some insurance plans may let you have the whole clinic lumped together, but I would definitely check if you sometimes see different docs). Also, with our referrrals, they only lasted for 6 months, so we would have to keep getting those renewed and stay on top of that.

 

[blondelawyer]

One other thing that I remembered from our HMO experience--when my husband goes to the clinic, he sometimes sees a different doctor (he has one main one that he sees, but sometimes she isn't there or for some other reason he sees another one of the CF docs). This caused a big problem with our insurance because the referral couldn't be made to the "Clinic" as a whole and had to be to the individual doctor. So...that is something to just be aware of (some insurance plans may let you have the whole clinic lumped together, but I would definitely check if you sometimes see different docs). Also, with our referrrals, they only lasted for 6 months, so we would have to keep getting those renewed and stay on top of that.

 

[blondelawyer]

One other thing that I remembered from our HMO experience--when my husband goes to the clinic, he sometimes sees a different doctor (he has one main one that he sees, but sometimes she isn't there or for some other reason he sees another one of the CF docs). This caused a big problem with our insurance because the referral couldn't be made to the "Clinic" as a whole and had to be to the individual doctor. So...that is something to just be aware of (some insurance plans may let you have the whole clinic lumped together, but I would definitely check if you sometimes see different docs). Also, with our referrrals, they only lasted for 6 months, so we would have to keep getting those renewed and stay on top of that.

 

[JazzysMom]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>blondelawyer</b></i>

One other thing that I remembered from our HMO experience--when my husband goes to the clinic, he sometimes sees a different doctor (he has one main one that he sees, but sometimes she isn't there or for some other reason he sees another one of the CF docs). This caused a big problem with our insurance because the referral couldn't be made to the "Clinic" as a whole and had to be to the individual doctor. So...that is something to just be aware of (some insurance plans may let you have the whole clinic lumped together, but I would definitely check if you sometimes see different docs). Also, with our referrrals, they only lasted for 6 months, so we would have to keep getting those renewed and stay on top of that.</end quote></div>

My husband had this with our PPO. A new doctor came to the group & hadnt signed on with the insurance yet or it hadnt been processed yet so when they billed it was denied. The office rebilled under the other doctor.