Question:
Need Help on understanding dedutable

Hello My name is Kristie, I am new to having Health Insurance, My dedutable is $1000 for individual or $1500 for entire family. If I had a persedure done what does the deductable mean? I am with United Health , is anyone out ther who understand this? and about on avreage how much would I pay out of pocket? i am a very poor person!!! will I be able to pay out the bill or do I have to pay up front? I have poor credit?    — sissykristy (posted on March 18, 2006)

March 18, 2006
You really need a little more information to be sure. For example, I have a $250 deductable and my insurance pays 80/20 (after the $250, they pay 80% of the cost and I pay the other 20%) but I also have an annual $1500 out of pocket maximum, meaning that if I have a lot going on, medically speaking, in one year, I will not have to pay out more than $1500, even if my 20% is higher than that. It sounds to me like your max out of pocket is $1000 for one person and $1500 for your entire family, because that's kind of how my insurance states it (XXX amount for individual, XXX amount for family) but I would call your insurance company or employer to be certain.
   — Becky Sue

March 19, 2006
Hello Kristie, My name is Elizabeth. OK, I work with insurance in a local hospital. One thing you and everyone should know or ask is "ARE YOU CONTRACTED" with whatever insurance one may have. Because I know with us, some procedures may cost $1500 and UHC may say all they are going to pay is $500 for the procedure. All that the facility can charge you is what UHC will pay. If it is less than your ded. Once that your Ded is met, your insurance will then pay at the coins level so if it is a 90/10 or 80/20 that makes your responsible for the 10 or 20%. Then you have an OOP to come out before you are covered at 100%. So say you are sick a lot, you may meet that at the beginning of the year and once it is met you are covered at 100% no matter what. So, if you are hospitalized once everything is met, you owe nothing to the facility. If you have any other questions, feel free to email me.
   — BlueEyes30

March 19, 2006
Becky has good information. However, I don't agree with her assumption that you meant out of pocket max insted of deductible. All policies are different and a 1000 deductible isn't out of the ordinary. Look at your policy and see what it percentage it pays. (like the 80/20 mentioned) If you have a percentage other than 100%, because this surgery is quite expensive, your out of pocket costs might be your policy's out of pocket max for YOU, not your family. As for your question: A deductible is what you have to pay before the insurance company will pay anything. (usually doesn't apply to normal doctor visits) Out of pocet max is the total amount you will ever have to pay out of your own pocket for the year. Once you have paid that amount, the insurance company will pay for everything else at 100%. This amount is usually between 2500.-12,000., it varies widely. Basically, if your total bill is 30,000 (pretty realistic) the insurance company will discouut that amount to about 10,000. (if you use a doctor/hospital on your list, you will not need to pay the difference) At this point you will need to pay the 1000 deductible, leaving 9000 left to be paid. If your policy pays at 80/20, the insurance will pay 7200, leaving you to pay 1800....a total of 2800. Now, these figures are totally made up in my own head using 5 years of claims payment experience to base the numbers. Your dollar amounts WILL be different, and they will come from many different providers. This is a simplified example to help you understand. If you can give us more information about what your policy pays, we can help a bit more. Your other question....yes, most providers will make you pay up front.
   — RebeccaP

March 19, 2006
Kristie-- even if you have insurance if you are low income most hospitals will have a program you can apply for to reduce or even completely forgive the balance your insurance doesnt pay. And I have never seen a hospital that wont let you pay payments for your balance, and will work with you to make it a reasonable monthly payment. I have been out of work for 2 months, and I got a $186.00 bill from my local hospital for what my insurance didnt cover. I applied for help and ended up they payed 80% of it, so we ended up only having to pay about $35.00. If you know what hospital you will be using you can call them ahead and ask for the business office and ask if they have assistance for low income people with insurance for whatever insurance doesnt cover. You may even be able to fill out the papers ahead of time. Good luck.
   — ValerieZ

March 19, 2006

   — beckiejud