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  #1 (permalink)  
Old 10-01-2010, 11:36 PM
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Default Health Insurance Jargons

Hi
Our insurance policy is changing from next year and I am to decided if we should do a major medical procedure (originally planned for next year) this year itself.

Can someone explain me the following --

The new policy has a Deductible of $500 for Employee, $1000 Employee + 1 and $1500 Employee + Family.

It also has a coinsurance of $1500 for Employee , $3000 Employee +1 and $4500 for Employee + Family

Per terms Surgery is paid at 90%

The question I have is --

If I have a suregery costing $50000 how much will insurance pay ? Is it --

1) $50000 - $500 - $1500

OR

2) $50000 - $500 - $1500 - 10% of 50000

OR

3) $50000 - $1500 - $4500

OR

4) $50000 - $1500 - $4500 - 10% of 50000

Anything else ?
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  #2 (permalink)  
Old 10-02-2010, 12:52 AM
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depending on the procedure, might be cheaper to buy ticket to India and getting it done there. Medical care even with employer sponsored health insurance is still more expensive than medical care back home
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  #3 (permalink)  
Old 10-02-2010, 02:50 AM
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Smile not enough information from your post

Hi there,

There isnt enough information and it can really depend on your policy. Your best bet is to call up the Insurance company and seek clarification , as they're in the best position to know the details of your plan. I am pretty sure you would need a pre-authorization before undergoing such an expensive procedure(unless its an emergency). and may not even be covered if its an elective cosmetic surgery or such.

There are too many ifs and but's to get a correct answer from a forum on Immigration
But for your reference, here are the jargons explained
Health Insurance Terms Glossary
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Old 10-02-2010, 11:14 AM
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Originally Posted by forgerator View Post
depending on the procedure, might be cheaper to buy ticket to India and getting it done there. Medical care even with employer sponsored health insurance is still more expensive than medical care back home
Thanks but no plans to do in India. It is a major surgery for our child and we do want the best. It is not cosmetic surgery and covered by insurance but I am too confused on what these terms mean.
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  #5 (permalink)  
Old 10-02-2010, 01:55 PM
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Default

I think it is, 50000 - 500 (one person deductible) = 49500

Coinsurance = 10% of 49500 = 4950

so your share is, 4950 + 500 = 5450
Insurance company share is, 44550

Above is for In-Network medical services, if it is out-of network, then your share is far more.
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  #6 (permalink)  
Old 10-03-2010, 01:05 AM
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Default

Quote:
Originally Posted by krishmunn View Post
Hi
Our insurance policy is changing from next year and I am to decided if we should do a major medical procedure (originally planned for next year) this year itself.

Can someone explain me the following --

The new policy has a Deductible of $500 for Employee, $1000 Employee + 1 and $1500 Employee + Family.

It also has a coinsurance of $1500 for Employee , $3000 Employee +1 and $4500 for Employee + Family

Per terms Surgery is paid at 90%

The question I have is --

If I have a suregery costing $50000 how much will insurance pay ? Is it --

1) $50000 - $500 - $1500

OR

2) $50000 - $500 - $1500 - 10% of 50000

OR

3) $50000 - $1500 - $4500

OR

4) $50000 - $1500 - $4500 - 10% of 50000

Anything else ?

you first need to pay $500 (or 1000/1500) as deductible. After that your insurance pays 90% and you will pay 10% as co-insurance. this goes on until your co-insurance is amount is finished. From then on insurance pays the full until your policy max is reached which will be around $2-5 million.
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  #7 (permalink)  
Old 10-06-2012, 01:13 PM
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Default

i am wanted to become sure after taking the insurance polcy of my life!
is it possible?
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  #8 (permalink)  
Old 10-06-2012, 08:17 PM
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Smile Coverage...

First, pick up the BEST coverage option provided by the insurance company. The best coverage will have HIGH monthly premium. Its OK to pick up the BEST as you known that you are going for surgery.

Most of the hospitals and doctors always look at your health insurance coverage "to milk as much as they can" from your insurance coverage. So, always be FIRM to see "NO" when required. Do not believe that Doctor or Hospital will always do what is best for you and your family.

Three parameters are crucial in the coverage:

1) Deductibles ( 500 $ / person etc)
2) Out of Pocket ( 3000 $ etc)
3) Network Coverage ( 90% or 80% etc)

If a surgery cost 60,000 $, the insurance company will bring the cost to 40,500 $ based on their agreed usual and customary charges with hospital and doctors.

Now, you will pay 500$ ( Deductibles) which brings the amount to 40,000.

For the first 25,000 $, insurance company pays 90% and you pay 2,500 $. By this you have paid the total 3,000$ amount which is your year's maximum out of pocket payment.

The Insurance company will pay the remaining $15,000 balance from their account.

For the given year, you will pay the max of "out of pocket" for any major surgery.

I hope, I provided the required explanation.
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  #9 (permalink)  
Old 10-07-2012, 02:57 PM
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Default

Quote:
Originally Posted by krishmunn View Post
Hi
Our insurance policy is changing from next year and I am to decided if we should do a major medical procedure (originally planned for next year) this year itself.

Can someone explain me the following --

The new policy has a Deductible of $500 for Employee, $1000 Employee + 1 and $1500 Employee + Family.

It also has a coinsurance of $1500 for Employee , $3000 Employee +1 and $4500 for Employee + Family

Per terms Surgery is paid at 90%

The question I have is --

If I have a suregery costing $50000 how much will insurance pay ? Is it --

1) $50000 - $500 - $1500

OR

2) $50000 - $500 - $1500 - 10% of 50000

OR

3) $50000 - $1500 - $4500

OR

4) $50000 - $1500 - $4500 - 10% of 50000

Anything else ?
You will pay: $500 + $1500 = $2,000. Rest will be covered by the insurance. Remember that the $50,000 could be made up of multiple items (like anesthesia, lab tests, radiology etc.) which might or might not be provided by in-network doctors, or might not all be covered. If that is the case, then there might be additional outgo from your end - could be another $1000 or $2000. Healthcare billing is complicated (unnecessarily so), but it is what it is.
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  #10 (permalink)  
Old 10-08-2012, 10:10 AM
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Quote:
Originally Posted by GCHope2011 View Post
You will pay: $500 + $1500 = $2,000. Rest will be covered by the insurance. Remember that the $50,000 could be made up of multiple items (like anesthesia, lab tests, radiology etc.) which might or might not be provided by in-network doctors, or might not all be covered. If that is the case, then there might be additional outgo from your end - could be another $1000 or $2000. Healthcare billing is complicated (unnecessarily so), but it is what it is.
I am sad yo hear about major surgery to your child. My best guess would be $1500 (deductible) + $4500 (out of pocket max) = $6000 as your is a family level insurance. The rest would be from insurance company.

$50000 - say this as final "total" amount after after insurance company negotiation with hospital

1) $1500 (deductible) - you need to pay that at any cost
2) 10% of $48500 (remaining amount) - $4850 You need to pay. But you need to pay only $4500 as it is out of pocket max. Some plans include your "deductible" in your "out of pocket max". If that is the case you need to pay on $3000.

One final thing is, Pay all this money through HSA or FSA. They are pre-tax dollars. That means you are saving $1500 to $2000 from your taxes...

Hope this helps..Again read through your insurance policy terms..
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  #11 (permalink)  
Old 10-08-2012, 08:13 PM
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Default Get The Procedure From Doctors Office And Get PreAuthorized

First you have to find the details of the procedure (with technical terms that will be understood by the insurance company. Doc office will know them) that will be operated. There will be some tests which may not be part of the surgery but those might cost you. You have to get the details from doctors office.

And you have to call the insurance company after you got the procedure code details. Insurance company will provide the details. Some time you have to get the details faxed by doctors office OR by you and insurance company fax them back OR to you about the approved procedures. Insurance company will provide the cost of those procedures also. Some times doctors office also know the cost that can be paid by insurance company if doc office is dealing with that insurance company.

What ever the details can be, you have to check with insurance company.
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