Who is you Health Care Provider?

[rebeccajo 14]

I confused about the term "deductible". What does it mean?

"Deductible" means the difference between what you pay out of your pocket and where the insurance begins paying. Let's say that you have insurance with a $200 deductible for medical procedures. You undergo a procedure that costs $450. You would pay $200, and your insurance company would pay the remaining $250.

Also, please create your VJ timeline!

The insurance company would only pay the remaining $250 if your coverage was 100% after the deductible is met. That is hardly ever the case. Most companies have coverage at 90/10 after deductibles or more likely 80/20.

"Deductibles" are not the same as "out of pocket" limits. Coverage at 100% only begins after "out of pocket" has been met.

Typical coverage would look more like this - $500 deductible with 80/20 coverage and a $2500 out of pocket maximum (dollar amounts and percentages can vary wildly).

Edited August 16, 2009 by rebeccajo

[kaffy 2]

The insurance company would only pay the remaining $250 if your coverage was 100% after the deductible is met. That is hardly ever the case. Most companies have coverage at 90/10 after deductibles or more likely 80/20.

Only 100/0 coverage I am aware of is if you work at a hospital. Since hospitals are self insured (most) services you have done there (both inpatient and outpatient) will have 100% coverage

Another thing I should mention is copay and deductible are different things and you will only pay one or the other. Copays are usually smaller amounts (i.e. $20 for office visit, $75 for ER visit) while deductibles are usually only applied for inpatient hospital stays, etc

[rebeccajo 14]

The insurance company would only pay the remaining $250 if your coverage was 100% after the deductible is met. That is hardly ever the case. Most companies have coverage at 90/10 after deductibles or more likely 80/20.

Only 100/0 coverage I am aware of is if you work at a hospital. Since hospitals are self insured (most) services you have done there (both inpatient and outpatient) will have 100% coverage

Another thing I should mention is copay and deductible are different things and you will only pay one or the other. Copays are usually smaller amounts (i.e. $20 for office visit, $75 for ER visit) while deductibles are usually only applied for inpatient hospital stays, etc

Sorry to say that I have seen insurance plans where there is both a co-pay and a 'cost share'.

Edited August 18, 2009 by rebeccajo

[Marilyn. 340]

we pay about $260 a month for a PPO plan with Cigna for my husband and I.. we don't have a deductible just copays and the insurance covers 100 percent of most stuff except for a few things like emergency room visits and hospital stays etc.. then they cover 90 percent...