High DEDUCTIBLE

[BecomingAnna 33]

Hello,

My surgery is scheduled for jan 2020. I submitted if i am approved before my deductible reset will it count. Will i have to pay my deductible before i can have surgery? My deductible and OOP is $6700 i have $1034 left to pay before it is met but all of that will reset the new year im So Confused please help 🤦🏽‍♀️

[catwoman7 10,852]

that's a question for your insurance company. I'd call their customer service dept (it's probably listed on your insurance card)

[Losingit2018 1,170]

The way that most insurance works is that the deductible resets and you start all over as of January 1. Wouldn’t hurt to call the number on your card to be sure though.

[lvidacovich 372]

13 hours ago, BecomingAnna said:

Hello,

My surgery is scheduled for jan 2020. I submitted if i am approved before my deductible reset will it count. Will i have to pay my deductible before i can have surgery? My deductible and OOP is $6700 i have $1034 left to pay before it is met but all of that will reset the new year im So Confused please help 🤦🏽‍♀️

Only your insurance can tell you but I would say no, it doesn't matter when you're submitted and approved you HAVE to have the surgery before your end of plan year. Mine was Oct 31st and I HAD to have my surgery before then since I had already met my OOP max.

Sorry, that's not what you were looking for I'm sure.

[AlwaysCruising 100]

Here are some basics that I hope will help you -

there are two basic kinds of plans. 1. You have a straight copay ( there may be different amounts for your pcp and specialists) and 2. A deductible and then a percentage (for a few lucky people that is 0, but usually it’s between 10-30%).

When you have a deductible, that means that every year when it turns over, that’s usually in January but for a few companies it can be in the fall, do you have to begin again and meeting your deductible. Remember that you aren’t paying the full price of a provider service but I instead you pay a discounted rate based on your individual insurance carrier (providers contract with each insurance company for a set rate and those usually very across states and whether it’s in a metropolitan or rural area), how much ”usual and customary” price/rate.

You pay the usual and customary rate until you meet your deductible, but once you meet that you only pay a percentage of the rate (this is called co-insurance). Once you meet your out-of-pocket maximum, then you pay zero. But all of that starts over when you get to the turnaround time each year.

An example. Let’s say your deductible is 300 (wouldn’t that be nice, mine is 6,000!) then a 25% co-insurance. Then you visit your doctor and the usual and customary rate for each visit is $100. So, once you go 3 times you will have met your deductible and the 4th visit and those after for the year would only be $25 each.

Don’t worry that you don’t understand all this, lots of people don’t. And there’s no reason you would without a lot of experience with either doctors offices or medical billing. Good luck!