Tuesday, October 30, 2007

Anon - It's not a deductible.

You mentioned you thought $2,500 'deductible' seemed high but that is totally ~not~ what I'm talking about. It's not a deductible, it's the max out of pocket amount.

The copay is only $15/appointment. The deductible is only $250. The ~max out of pocket~ is $2,500.

See, "copays" is just your portion you pay at an office visit. It doesn't go towards max out of pocket. It's just your portion per office visit. This is what you were talking about in your comment.

A "deductible" is the amount you have to pay first, before any other coverage kicks in. IE: Let's say you go to the doctor and the visit costs $200. Since my deductible is $250, I would still have to pay that $200. Then, for the next $200 appointment, I would only have to pay $50, which then my deductible of $250 would be met and the rest of the balance would be paid.

For "Max out of pocket", this is an amount that the insurance says it the max you will EVER have to pay for within a year. It doesn't include copays though. So, let's say I had a $12,500 procedure done, say, IVF#1. The plan covers 80% ~after~ deductible.
~ $12,500 total cost.
~ minus $250 deductible which I would have to pay.
~ This would leave $12,250.
~ My insurance would cover 80%, which is $9800, leaving me with a balance of $2,450.
~ But my "max out of pocket" is $2,500. So I since I already paid $250 towards the deductible, I would only have to pay $2250, because that would add up to $2,500.
~ After that, my insurance would pay 100% - so after all is said and done, I would only pay $2,500 and my insurance would pick up the remaining $10,000.
~ For any FUTURE bills, I already paid my max out of pocket. So everything would be then covered at 100%. I could have another $12,500 IVF#2, but I wouldn't pay anything, as I already paid $2,500.

Get it? - it's not a $2,500 deductible I would pay each time. This insurance is a GOOD thing. What you were thinking would be robbery!!! Ack!!

8 comments:

Anonymous said...

yeah im not the anon you are talking about here but i thought this would be a good time to tell you that you never say hello nor do you ever say anything at all to me after the several messages i have left you but i guess you pick your favorites which are only the people who have IF issues as yourself. you're so kind.

nancy said...

Huh? If I don't know who you are, how am I to respond? I usually always go to the blogs of people who comment. It's a give/take thing - do you know how much commenting it would take to say a "hi" to every comment? It's like sending a thank you note thanking someone for sending you a thank you note.

I'm really sorry you feel so darned put off. I certainly didn't mean it. I get a lot of anon comments, I have no idea who leaves them all. Please leave your name and I'll be able to know who you are! How do I know if it's 20 different Anons or just one?

Again, really sorry you feel this way Anon, but when you stay anonymous, I have no way of knowing who you are!

nancy said...

By the logging, all I know is you are from College Station, TX. So hello and thank you for commenting whomever you are from Texas!!!

Sarah R (happychic22) said...

You do have good insurance, Nancy. I would take it! I, on the other hand, have shitty insurance. My bi-weekly premium is $128.12, my deductible is $1,000; and my annual out-of-pocket maximum is $5,000. It's an 80/20 co-pay. This is for the family plan.

(A person is better off on the single plan, which is only about $20 a paycheck and the out-of-pocket maximum is $3,000.)

We have a fluctuating premium so that if I work less hours my premium goes up significantly unless I use accrued PLV time. If I work more hours I get it a little bit cheaper.

The corporation could (in my opinion) contribute more which would make the employees' portion much less. I love my job, so for now I'll deal with the insurance. Oh, and just last year it was $112/paycheck and $3,000 out-of-pocket max, so it was a real nice SURPRISE this year when that went up $2,000 just in time for my baby!

I always compare with others' insurance, and so far mine is the worst! I work for a corporation that has 800ish employees, so IMHO it should be cheaper.

:)

Amanda said...

I was going to make some sort of joke about the original Anon poster mistaking your insurance for a crappy BCBS plan...but the current Anon poster threw me off of my game. :-(

Either way...your insurance rocks!

Katarina Jelly Beana said...

A) your insurance rocks!!!! I'm jealous!

B) To Anon: While it is a nicety when a blog writer replies to responses, blog etiquitte does not dictate it is necessary. If you are interested in getting to know someone better, please consider email or other direct correspondence.

C) To Nancy: I don't wash socks before I wear them either.

Anonymous said...

I appreciate the education on Health Insurance 101. LOL I realized after I read it again, that I misinterpreted your first post as a "deductible" instead of max out of pocket...confusing the two. The math lesson wasn't necessary.

nancy said...

You never know what someone may not know :) It's better to give more info than leave someone confused!