Deductible - when do you pay it?

Hi everyone,

I am currently researching revisional surgery (band over bypass). I have AETNA Choice POS which will cover it with an In Network Dr.    Found one (not an easy thing), he's local. I have an appointment on Monday. When I called his office I asked if he charges an additional fee and they said No. AETNA told me I have a $2,500 deductible and they will pay 80%. Nobody at AETNA ever really gives me a straight answer as to who the deductible is paid ... 

Is this to be paid to the Dr? the hospital? directly to my insurance company? Before the surgery is done or after? This can also be a deciding factor in having this surgery done since I do not have money like this to put up front... 

My company is revising our health policy (i.e.  raising emps rates, "cheaping out") as of 4/1/09 ... I am very nervous they will EXCLUDE this from our policy... I feel like the clock is totally tick tick ticking.

I do have a Dr's appt. on Monday (3/8/09) and will ask them about this. I am just wondering if I am wasting my time getting started with his if I have to put a chunk of $$$ upfront (deductibe) I don't have...

Any info would be appreciated ...

Thanks,
Michele
 

oops ... meant to say $2,500 deductible and AETNA will pay 80% of the fees, I will be responsible for 20%! 

also, I should have read what I typed before I submitted ... lol   dr's appt is 3/8/2010 and new health insurance policy is to be implemented on 4/1/2010

My interpretion is that if your surgery cost $10000 and you have not paid out the $2500 deductible for the year to the insurance company then you will be responsible for the $2500 plus 20%(coinsurance is 80/20)of the left over bill, so your bill will be $4000. If you have already met this for the year then your just responsible for 20% so you will owe $2000.

The cost will be split up to between the hospital, the surgeon and any assisting surgeons, and the anestheslogist (sp?).  You will get separate bills from each person.

The insurance company would process the claims and the order they are processed determines which claim applies the deductible and consurance (up to our out of pocket limit if any).  They simply reduce the fee schedule by your cost share.  If the provider is in network the billed charge is not relevant.   For example if the surgeon's claim is processed first, and his fee schedule is $3000 for the surgery, then they would only pay $400.00 ($2500 deductible and $100 coinsurance is your liablity).

Some doctor's want any deductible/consurance up front, particularly if you have a high deductible like this plan.

GigiNorth is right.  The deductible gets applied to the claims as they come in and are processed.  For that reason, and I tell my own parents this, do NOT pay any provider a deductible until all the insurances have processed the claim. 

If Dr X makes you pay him the deductible, but Y Hospital gets their claim in first and it gets processed before Dr Y's, the deductible will get applied to the Y Hospital claim and they will want to collect it from you, but you paid it to Dr X.  His office will pay you ... eventually.