Skip to main content

de-duct-i-ble

de·duct·i·ble
dəˈdəktəb(ə)
noun
NORTH AMERICAN
  1. 1.
    (in an insurance policy) a specified amount of money that the insured must pay before an insurance company will pay a claim.

This is a PSA

Working in the medical field we are finding more and more often people do not understand insurance. And I don't blame you (well, not entirely). Insurance is confusing. And frustrating. And usually seems unfair and ridiculous. But, if you are going to have it and pay for the premium you should probably at least try to understand it so that when you get a bill from your doctor you aren't floored by what it says. 

The very first thing I think people need to learn and understand is what a deductible is. Most insurances have it and as of the last couple years they seem to have higher and higher deductibles. What you need to know about this, what is most important, is that you have to pay this (usually ridiculous) amount before they will pay a cent of your medical expenses. 

So let me just give you an example of how this works.
1. You come to the doctor for an appointment.
2. We bill the insurance for the visit. Let's say $100.
3. The insurance processes the claim and sends us the EOB (Explanation Of Benefits). Let's say that you have a $1000 deductible. We billed for $100 and the insurance allows $85. This is because doctors and insurance companies have a contract with each other basically saying that because you have insurance you will get a discount when we agree to bill that insurance. 
4. We send you a bill for $85.
5. YOU PAY THE $85.....and are nice about it because when you signed up for insurance you agreed that you would pay your deductible (even if you don't really WANT to).
6. That $85 goes towards your deductible, which means you now only have to pay $915 more in medical expenses before your insurance will pay for things. Lucky you! 

Still have questions? I'd be happy to help...or at least try.

Comments

Post a Comment

Popular posts from this blog

The Black Hole at the Post Office

"I just got a collection's notice but I've never gotten a bill." "That is my correct address but I've never gotten a statement." "Yes, that is my phone number but I never received a call or message."   **Side note: We document every statement sent and phone call/message left about a bill.** It's funny how we send multiple bills/statements and we call the parent/patient multiple times and leave multiple messages about their bill and yet they never know they have a bill until they get the notice saying we are sending their account to collections. So we've been sending bills to the same address that we sent the collection notice, we've been calling the same number that they are calling from and yet somehow they've never gotten a bill. Likely story. Which posses the question, where do all the statements that we sent go? They weren't returned to our office and the patient says they didn't get them...where are they? T...
Post a Comment
Read more

Kids Share Germs?

"Hi, I'd like to make an appointment for my sick child." "Okay, can you come at 11:00?" "Do you have any after school appointments?" ...Let me get this straight, your child is sick, sick enough to need to see the doctor, and yet, you sent them to school? "...I have a 2:00 available." "Okay, that works." "Alright. And what are their symptoms?" "Well, he's just coughing a ton." ...Oh, good. Coughing all over the place. Infecting other children. I mean, I pray it is just asthma acting up or allergies but even if it is, no one likes to be coughed on. PSA: If your child is sick, DO NOT SEND THEM TO SCHOOL. Kids are gross. I hate to say it, but it's true. They stick their fingers in things, (mouth, nose, etc.) and then touch everything! Keep them home. Especially if they are in elementary school. I promise they will be ok if they miss a day or two. And if they are in junior high or high school a...
Post a Comment
Read more

Baffled

I remember in school I was reminded over and over, from early on in my education, to read the directions. Every test we had, "Read ALL of the directions first." Failure to do so could result in a wrong answer or extra work if the teacher gave out one of those "trick" tests. (You know you had one, where there are a lot of questions on the paper, yet at the end of the directions it says, "only write your name" or something similar, just to see if you followed the directions.) So, why is it, that adults have such a hard time following directions? And on easy tasks, none the less. It baffles me. Filling out paperwork: When I hand them the paperwork I say, "fill out both pages and bring it back with your insurance card." It never fails, 1 out of 3 will bring it back, first page only filled out. Or I will have to ask for the insurance card, or (and this is the most common) I find that they didn't fill it out completely. We need ALL that informatio...
Post a Comment
Read more