BC/BS-FEP-- Coinsurance Question

I'm confused. 
oh HI...

today my husband and I went for our initial consult with the Bariatric Team.  We are both having surgery (RNY) 

This is what they told us for our insurance which is Federal BC/BS

Copay:  $20.00 (for the first office visit)
$200.00 inpaitine copay (hospital stay)
Deductible $300.00  (we've met this already)
COINSURANCE:  $5,000.00   THIS IS WHAT CONFUSES ME.  What does this mean???
Coverage 85%  
program fee  $xxx   (includes all NUT and PSYCH evals and supports before surgery and for ONE YEAR AFTER)


criteria:

no set SWL visit required.

the doctor requires 3 months.  today counts as one.  


so I'm trying to figure out how much I will pay for each of us.  

and we have to go get our own medical tests but our insurance covers them just like regular tests.

so can anyone explain what this Coinsurance things means?

thanks in advance.

 Hi there. Just so happens that I am a Medical Coder/Biller. So here goes . . .

1st thing to know:  Does your surgeon participate with Federal BCBSM?  If he/she does then once your deductible is met it works like this.  Dr. charges $120 (made up number) for office visit.  Your BCBS approves $100.  Because he/she participates, $20.00 is written off and you can not be charged for it.  Now of the remaining $100, BCBS will pay $85 (85%) and you will be responsible for $15 (15%).  Once you've paid your $3000 in coinsurance, your insurance will pay at 100%. 

** Keep in mind, that if your Dr. does not participate with BCBS, you will be responsible for 15% of the total charge, not the approved amount. **

Another thing, is that $5000 coinsurance for individual or family??

Hope that helps!

thanks for answering.

the surgeon is a participating preferred provider.  He is part of a blue center of distinction

the catastrophic protection is 5,000 per family for preferred providers and 7,000 for non-preferred

we have met  $504 as of 2/26/09

we also have a family deductiable of $600.00 and have as of 2/26/09 met nearly $445.00 of that.

oh and office visits are always a $20.00 co-pay for preferred providers I think.  I have never understood insurance. I just pay the bills.   I just want to understand this and try to get an idea of what we are going to have to pay.  I think based on what the benefits person said today that they get $17,000 per surgery so we would have to pay 15% of that?  (or 2550 each?)

hey nessa,

I don't understand that coinsurance bs. sorry. i just wanted to say congrats on your first visit. were you and hubby happy with DVR and his staff? My 3rd visit is thursday and it is driving me nuts to sit and wait. LOL.

Luvbunnie,

thanks!  we are pleased.  very pleased.   Well DH is not he has to have a sleep study and get a CPAP machine... 

LOVED the staff.  and the new office is HUGE...

our next visit is April 8th and i can't wait.

Hey, Nessa! I don't have to pay coinsurance with my policy, but just wanted to say hi to a familiar face (same name on 3FC)!

Hey Jilly!  I thought that might be YOU!  good to see you.

Hi!!
Congrats on the surgery...this is how my co-ins. works. I have a 750 deductible (no copay) once I meet my deductible the co - insurance kicks in  my policy pays 80/20 (in network)  so I pay 20 percent of any service until I meet my total max out of pocket (co-insurance) so I will pay 20 percent until I've paid $3000 and then my coverage will be 100%.

My surgery is April 14 and I have not met my deductible or max out of pocket so the most I will pay for my surgery is $3750...(my $750 deductible + $3000 co-insurance)

Hope this helps

it does.   so  we would have our  deductable and our co-insurance... and i bet since two of us are having surgery this year we will meet it.