Insurance stuff, sooo confused

[susunorm 95]

I’m not sure if I’m the only one but I just do not get how insurance works. I know that I have to pay my deductible first before they start to cover anything. So here is my insurance stuff and hopefully you all can explain. I have spoken with atena but I’m still not positive about it. So my doctor is in network. My deductible is 1500. In network annual co insurance is 3100 including deductible, out of network deductible 2675. Out of network co insurance 6250. So from what I understand. Once I reach 3100 of paying my cost. They cover the rest, as long as in network?

Thanks for reading guys!!

[Creekimp13 5,841]

That sounds right. But to be safe, you could call an insurance rep and get the answer straight from the horse's mouth.

[susunorm 95]

Thank you!!

[Matt Z 4,140]

8 hours ago, susunorm said:

I’m not sure if I’m the only one but I just do not get how insurance works. I know that I have to pay my deductible first before they start to cover anything. So here is my insurance stuff and hopefully you all can explain. I have spoken with atena but I’m still not positive about it. So my doctor is in network. My deductible is 1500. In network annual co insurance is 3100 including deductible, out of network deductible 2675. Out of network co insurance 6250. So from what I understand. Once I reach 3100 of paying my cost. They cover the rest, as long as in network?

Thanks for reading guys!!

This is going to depend on your insurance.
Most don't cover 100% after the deductible is met.

Like mine is 80% coverage after, so after I meet the deductible, I'm required to pay 20% of whatever the charges are after the deductible.

They should have spelled it out for you more clearly.
For me, if the cost of a procedure is say, 10,000, and my individual deductible is 1000, then I'd be responsible for the 1000, then 20% of 9000 or 1800. So my total out of pocket would be 2800. Everything for the rest of the year now will be at the 20% of the total since I met the deductible. Some insurances have a "Max out of pocket" where you don't pay for anything after that max. Would be worth talking to your insurance company to find out exactly what your cut offs are and what you can expect after meeting them.

[Creekimp13 5,841]

My strategy with these things is to try to get it in writing from my insurance company up front. Ask specifically about all the out of pocket costs I can expect, and see if they can give me an estimate. It's a pain to wait to talk to someone....but they're used to this, and if you're polite and patient, they'll help you figure it out and give you much better answers than we can.

[shelleycakes 2]

On 6/20/2018 at 9:05 PM, susunorm said:

...My deductible is 1500. In network annual co insurance is 3100 including deductible,..... So from what I understand. Once I reach 3100 of paying my cost. They cover the rest, as long as in network?

Yes, you are correct. Once you meet your coinsurance limit or out of pocket maximum of $3,100 Aetna will pay 100% for in network providers.

[TaylorMade4One 105]

Yes, you are correct. Once you meet your coinsurance limit or out of pocket maximum of $3,100 Aetna will pay 100% for in network providers.

That's good my out of pocket is $6k!! And I have Aetna too!

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[Auroragirl4489 88]

Once you reach your out of pocket max everything is covered at 100%