Can someone help me with health insurance?

CAN SOMEONE PLEASE HELP ME UNDERSTAND MY HEALTH INSURANCE POLICY?

  • I have a $5000. deductible on my husbands health insurance policy, there is probably about $500.00 been paid towards it this year. He has to take a polysomnography next month, it will ...show more

  • Answer:

    If the hospital is in your network, the $4000 will be discounted to the rate they have contracted with your insurance company. Say it's $4000 before repricing. The insurance has a contract with the insurance that they will discount say 20%(this is just an estimate-no one really knows what the discounted rate is but the insurance and the hospital)-so the amount that will be applied to your deductible is $3200. The hospital may ask for some or all of that up front. You need to contact the hospital and ask them what their policy is on that to avoid any surprises and possible cancellation of the test on the planned day.

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Hi. If you have a 5k deductible on your insurance policy it means that you will have to afford any expenses up to 5k. Using the example in your question, 5k deductible - 500.00 paid = 4500.00 you still have to pay for the insurance to kick in. That said, from the remainder deductible or 4500.00 - 4000.00 for the test = 500.00. Assuming you will go ahead with the test, any costs associated with it will have to be paid by you and a bill wil be sent to you. In other words you are responsible for the test and associated costs up to your remaining decutible of 4500.00. Any future amounts over 5000.00 willbe covered by the provider.

freudiancircle

First of all, the $4,000 cost is probably the "retail" price....that is, the price that someone would have to pay if they have no insurance. The actual cost in your situation is whatever the agreed upon rate is for that procedure between the hospital/provider and the insurance company. Secondly, most insurance works such that you will pay the hospital after the claim has been submitted to your insurance company. You might want to talk to the hospital business office so you know for sure.

Charles C

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