Health Insurance Questions

[sammy060382 1]

Hi everyone,

My husband and myself moved to the States a couple of months ago and recently obtained short term medical coverage as both of our employers are still in Canada and don't currently offer health care in the States.

Anyways, I have a couple of questions regarding coverage down in the States. This may differ from provider to provider but I thought i'd ask:

1) The concept of deductables are new to us. Since we have a deductable, do we need to send our provider all of our medical expenses up to the deductable amount to prove we have reached that amount?

2) When we have reached our deductable amount and the insurance company will start co-payment, do we need to send in claims for any doctor's visits and our provider mails us a check later or do we just show our insurance card at a doctor's office and the co-payment is automatically deducted?

Thanks for any help you can provide,

- Sam

[Mononoke28 135]

Hi everyone,

My husband and myself moved to the States a couple of months ago and recently obtained short term medical coverage as both of our employers are still in Canada and don't currently offer health care in the States.

Anyways, I have a couple of questions regarding coverage down in the States. This may differ from provider to provider but I thought i'd ask:

1) The concept of deductables are new to us. Since we have a deductable, do we need to send our provider all of our medical expenses up to the deductable amount to prove we have reached that amount?

2) When we have reached our deductable amount and the insurance company will start co-payment, do we need to send in claims for any doctor's visits and our provider mails us a check later or do we just show our insurance card at a doctor's office and the co-payment is automatically deducted?

Thanks for any help you can provide,

- Sam

Sam,

I have a high deductible in my insurance and every time I go for a doctor's visit (any medical doctor), their office bills my insurance and they handle the billing. Then I get an EOB (explanation of benefits) in the mail that shows how much my insurance covered and what was not covered which is my responsibility to pay. Once I reach the yearly deductible, then I just pay a very small amount. There are exceptions to this like yearly medical exams, yearly lab tests, etc. which my insurance covers at almost 100% depending on the lab tests the patient needs.

In the US, most medical offices take care of the billing and you just wait for the bill unless you specifically have an insurance company that requests you pay in full at every visit and then submit the paperwork to get reimbursed.

Diana

[ria_s 0]

Hi everyone,

My husband and myself moved to the States a couple of months ago and recently obtained short term medical coverage as both of our employers are still in Canada and don't currently offer health care in the States.

Anyways, I have a couple of questions regarding coverage down in the States. This may differ from provider to provider but I thought i'd ask:

1) The concept of deductables are new to us. Since we have a deductable, do we need to send our provider all of our medical expenses up to the deductable amount to prove we have reached that amount?

2) When we have reached our deductable amount and the insurance company will start co-payment, do we need to send in claims for any doctor's visits and our provider mails us a check later or do we just show our insurance card at a doctor's office and the co-payment is automatically deducted?

Thanks for any help you can provide,

- Sam

Usually with insurance, you go to a provider then show your insurance info. Provider can call your insurance and deduce how charges would be covered. Then once services are rendered, your provider bills your insurance. Your insurance processes the claim and figures out how much is allowed and what plan should pay. If you have a deductible to meet, then the allowed amount goes towards that first. Once that has been met, your insurance starts paying on claims.

Insurance payment depends on whether or not the provider is willing to bill your insurance. Most do; for those that don't, you pay upfront and submit the claim to your insurance yourself with proof of payment. Then your insurance reviews then sends you a check for reimbursement. Either way you get an explanation of benefits or EOB that lets you know what is patient responsibility, what plan paid if any etc.

Depending on your plan, most insurance do cover routine healthcare at 100% although some like mine might have a maximum that once reached means you have to pay a portion of it. Also depends on what kind of plan you have. Mine is PPO so I have to make sure I go to a provider that is in network otherwise charges that are over the usual and customary end up being an out of pocket expense since insurance won't pay for it.

[CaliDreamin' 2]

We're in a similar situtation. Who did you get your short term medical coverage with? And what are you're monthly payments like?

[Penguin_ie 5,993]

We got ours with Blue Cross Blue Shield, coverage was about a dollar a day per person, more for under 2's.

[ria_s 0]

We're in a similar situtation. Who did you get your short term medical coverage with? And what are you're monthly payments like?

We're at low $100+ but that's including my husband. We get wellness and tobacco credits since we both do the health risk fair and we both don't smoke. I've seen some healthcare plans but they either just have too high a deductible or too high premium rates. My health insurance plan is through a self-funded company.

[ria_s 0]

We got ours with Blue Cross Blue Shield, coverage was about a dollar a day per person, more for under 2's.

What's the deductible on it?

[Penguin_ie 5,993]

What's the deductible on it?

I can't remember, it was more than 2 years ago. I think it was very low- $500 (per person)? That may vary by state anyway.