Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

I truly think my DH's plan is the worst in the world. I have never experienced such a horrible plan. DH says - typical. So I am curious.

Do you have an in-network deductible? If so, how much? Also, if you go to an in network dr. do you pay a percentage fo the cost? What about out of network?

TIA!

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

Yes.... Not only do we pay full cost for the insurance plan (DH's employer pays nothing toward it), but after we shell out $$ for the plan itself, each of us have a $2000 deductible (caps at $6000 for family) and we have a 20% coinsurance. And yes, it's all in-network, because we have NO out of network benefits at all. If we see a doc not in our plan, they won't even look at the claim, they pay $0.

It truly sucks. DH had a brain tumor removed last year and the bills we are still receiving and paying are just gross, plus I am pregnant now, so while they say they cover pregnancy 100%, so many lab tests and sonos I've had are not covered fully, leaving me to foot the rest.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

yes..
we have the same...
we pay $500/month for the insurance, and then have to pay a $2500 deductible before we can them to pay anything.. after that it is 80/20 until you meet the out of pocket max of 5k...

we have no out of network benefits at all

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

yes. $500 in-network deductible for each of us, and a 10% coinsurance.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

No, that is not "typical" per se but it is heading towards being the norm. My friend's DH's job just instituted this insurance switch. They went from United Healthcare and just having a copay to now having a $5K family deductible and then having to pay 20% thereafter. They were planning on TTC this year but now are holding off until they save up more money to pay for the pregnancy/delivery/hospital stay.

My brother was given this option at work and took it thinking he'd save money. Three months ago he passed out and needed to go to the hospital and have a CAT scan. In hindsight, as he was borrowing money from my mother to pay his hospital bill, he wishes he had not "cheaped" out.

I think these high deductible plans are horrible I feel very blessed and fortunate for my husband's insurance where I pay my $20 copay.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

We also have a high annual deductible, $5000. We have some out of network benefits but they are very limited and the deductible still applies.
Before this we were paying $1400 per month for a policy with very low deductibles.
We've never had health insurance that was paid 100% by an employer, so this was the choice we made to offset the cost of the premium.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

We do.. and altho I use a common and widely known insurance company for a 'provider' the truth is my company is large enough we 'self insure' meaning my company literally pays the claims. The carrier only does paperwork and keeps the claims process impartial. Obviously we use 'the network' from the provider as well.

We pay some not all of our premiums (feels like it since I paid $5k of the full $11k last year for our insurance). We also pay $2k per person deductible and then 20% of what's left not paid thru our network.

Generally I take out an HRA for the deductible amount minus $500, we get a 'free' 1500 for joining up with a health prevention plan. Then I FSA another $1000. This year I was left with $29 unused on my FSA and still have about $300 left on my HRA (which rolls over)

I absolutely, positively ALWAYS check network status before seeing anyone. Frankly you can't TOUCH me unless you're covered. That includes once a long time ago sitting in the ER after a bad car accident dying in pain telling the Xray dude ... Wait.. are you covered by my insurance? same the week after AJ was born and I was in the ER. Nothing is ever so bad (thankfully) that I can't find a network doctor.

All that and I *JUST* paid off one of my three open medical bills. I seem to ALWAYS have more medical than credit bills in the mail *shrug* but at least there's no interest and they take whatever I can give.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

i still have one of the good plans. It's not the best but it's pretty good.

I have no co-pays but a $300 in network deductible. $600 out of network with co-insurance of 70% up to $2000 oop.

Many plans are self funded and that's why the deductibles and co-insurances are so high. Why so many people have huge medical debt and why we need an overhaul of our health coverage in the US.

Some people cannot afford the premiums let alone the co-insurance.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

We pay similar ded & co-insurance. Its

crazy and $$. We used to have excellent

ins and kept ourselves & kids healthy. Now

we pay too much. The Health Care system

in America is BROKEN & unfair!!!! But lets

keep on supporting other countries &

illegal aliens & promote greed between

providers and Ins. Companies!!!

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

I have a high deductible health plan.

Either in or out of network, I'm responsible for the first $2000 of my care. The company kicks in $750 in a fund and I have to cover the rest with FSA or cash.

After the deductible, in network care is for the most part covered at 90% until I reach the out of pocket maximum which is something like $3500. Out of netwrok they cover like 60 or 70%. The rates for prescriptions go up every year to the point where it's insane.

A few things are good. One is preventive is covered at 100% so I don't pay for GYN or flu shots, and "maintenance" meds are always covered at the prevailing rate, so I never have to pay 100% out of pocket, even in my deductible period for them. What that means is I always pay the same for my asthma medication, but until I meet my deductible I'm paying HUGE amounts for my allergy meds and anything else I may need.,

This is for me alone. As of right now DH and I are on separate plans. We realized it wouldn't save us anything to be on the same plan.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

My deductible is $300 individual
$900 for family
$25 doctor copays
$40 for specialist

If I am not subject to a copay - coinsurance pays 80% (after 300 deductible)
if I am subject to copay - coinsurance pays 100%

Out of network will pay 60% after a 1200 deductible

The plan costs me $2900 for the year for me and my husband

I have united healthcare choice plus through my employer

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

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Message edited 1/5/2012 1:15:22 PM.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

We have a high deductible plan at work. Our new deductible is $5800 for singles and $11600 for employee + plans. I am fortunate that my employer pays a large portion of the deductible for us. But it does result in a larger weekly deduction. It balances out though. Once the deductible is met, everything is paid at 100% by the ins company. We do not have out of network benefits, unless it is related to a hospital stay.
My son was born early and spent 7 weeks in the NICU. In the end, it will cost me less than $3k for his birth and care. We met the deductible. His hospital stay and subsequent care is all covered. So is his care at out of network docs since he saw them in the hsp.
Like I said though, my employer pays a large part of the deductible, so it works.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

We have that. But we're lucky because it's a $500 deductible, then the insurance company covers 90%.
DH pays $400 a month towards it for our family of 4.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

We have a plan through DH's job but we pay for all of it. DH works for a small firm and the partner has allowed him to choose the plan. We do not have deductibles for care (we do for pharmacy) nor do we have coinsurance. Last year we chose an EPO, but this year we decided on an HMO so we could save $300 a month. I was not comfortable with having coinsurance. To me it feels like a gamble. I rather pay a set amount every month rather than hope that we wont have to go to the hospital. We were thinking about doing a high deductible plan but decided against it. It is something that you have to commit to. I do know that with a high deductible plan you can have an HSA account which allows you to pay the deductible with pretax money. That pretax money that you put into that account then rolls over to the following year. And HSA is different from an FSA though. The cost for health care is disgusting!

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

DH's company had to lower their coverage, so we decided to buy up. We have the best plan they offer: $300/indiv; $1300/family 10% coinsurance

We've had two big health issues this year and I feel like we are not paying 10%, but I'm sure the bills will catch up to us.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

For in network we have a $1,000 deductible each, but $2,000 family. We have no out of network benefits. After that, regular office copay is $25 and specialist is $40. ER visits are $100. Prescriptions have been really cheap for us - couple of bucks here and there.

BUT, what we pay for the insurance is ridiculously cheap for family coverage (I think). About $315 is taken from DHs paycheck each month, but my company reimburses me for my portion since it's cheaper for me to be on DHs than for them to pay for my coverage through them. After the reimbursement, we pay about $100 a month. So I don't complain about the $2k deductible considering family coverage at my company is close to $1k per month.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

Message edited 1/5/2012 11:49:00 AM.

Re: Insurance Question - Do you have an "IN NETWORK" deductible. What about in-network co-insurance?

yup.6000 ded.for family

there was a copay option. cost1000 more in premium and still could be upto 6000 out of pocket. if things like surgeries and lab work factored

also be ware colonoscopy could run 1000. they dont consider it wellness if they send off for testing.