Health Care Insurance? - Toyota Yaris Forums

jamal1984 · 08-19-2010, 10:15 AM

I'm 26 thinking of get a health care insurance before something really happen.
Newbie to this, don't know what to look for.
Visited healthcare.gov but can't find much.
Visited a few website and here is what i found.
Premium $187 a month with Calendar Year Deductible $1500.
What is Deductible and in network, out network?...
What am i look for?

Thank you

2009BBPliftback · 08-19-2010, 12:23 PM

I work in healthcare dealing with insurances on a daily basis. "In network" is when you use selected facilities/doctors that have a contract with your insurance company. "out of network" is just the opposite when you use out of network your benefits (depending on the policy) they will pay at a much lower rate than if you use "in network". The Deductible is what you pay out of pocket before your benefits kick in. Hope this helps somewhat.

jamal1984 · 08-19-2010, 12:57 PM

Quote:

Originally Posted by 2009BBPliftback

I work in healthcare dealing with insurances on a daily basis. "In network" is when you use selected facilities/doctors that have a contract with your insurance company. "out of network" is just the opposite when you use out of network your benefits (depending on the policy) they will pay at a much lower rate than if you use "in network". The Deductible is what you pay out of pocket before your benefits kick in. Hope this helps somewhat.

Thanks another question.
Let's say if i hurt my hand and i'm go to the emergency room, and see a doctor...and the total came out less than $1500 do the insurance will pay for it? or i have to pay for it? Since the deductible is $1500.

DevilGirl · 08-19-2010, 01:00 PM

I would agree with BBPliftback on the in/out network definition.

As far as the deductible part though, slightly better explanation, with example. Say you get sick and you go to the doctor's office. Your insurance will pay a portion of the office visit bill, and you pay the "co-insurance" amount (typically between $15 and $45, depending on the insurance plan). This co-insurance amount goes against your yearly deductible.

So, for instance, you go to the doc ($25 co-insurance office visit), they say you need to see a specialist ($45 co-insurance office visit for specialist), and you are then told you need to have surgery.
The surgery involves a pre-op appt with the anesthesiologist (another $45 co-ins office visit for specialist), as well as the hospital stay, and various other related charges.
The insurance will pay the bulk of the cost, after your deductible is satisfied. So in this case, you paid out $115 in co-ins for office visits. The deductible is $1500.00. This leaves $1385.00 for your deductible.
The total cost of the surgery (hostpital, surgeon, anesthesiologist) is $15,000. Out of the surgery cost, you pay $1385, which is the remainder of your deductible. So there is still $13615 that the hospital, surgeon, and anesthesiologist are looking to receive.
The insurance company would pay either the whole amount, or an agreed amount and the hospital/surgeon/anesthesiologist will write-off the remainder (frequently happens).

I know this from experience, as I had surgery in 2008, and only had to pay approximately $1000 out of the total $17,000 cost, due to my deductible.

DevilGirl · 08-19-2010, 01:01 PM

Quote:

Originally Posted by jamal1984

Thanks another question.
Let's say if i hurt my hand and i'm go to the emergency room, and see a doctor...and the total came out less than $1500 do the insurance will pay for it? or i have to pay for it? Since the deductible is $1500.

Depends on the particulars of the plan. I had an emergency room visit last year, and should have had to only pay the co-ins amt for ER visits of $250. I didn't get billed though. If you are admitted, the insurance typically covers most of the costs.

torontoo · 08-25-2010, 03:30 PM

Hello,
Yes you are right we have to take insurance. this will really help in future and at that time you will think that you did a right thing.

thanks!!

_________________
TurboFire Workout for cheap

swidd · 08-25-2010, 04:59 PM

At age 26 you should be able to do better than $187/month. Around here, a single hospital/doctor network runs the entire city, like pretty much a monopoly, and their plans start at $60/month for the highest deductible/worst coverage, and run $120 for a reasonable plan. You have to assume that you can flip $1500 over in an instance if you have an accident, lose your job, become unable to walk and need a wheelchair, hospital bed at home, a nurse, girlfriend to quit her job to stay with you all day long to help.

If you don't have $1500 laying around to pay a hospital if you get injured, go with a lower deductible... Or buy short term and long term disability insurance, and look into plans which let you pre-pay the first $1000 or entire deductible. Also look into a health savings account, through which you can fund medical expenses (prescription pills, co-pays (the deductible)) through a tax-exempt account that you fund through pre-tax payroll deductions. If you have any recurring medical expenses, or foresee having any minor issues at all, it is your loss if you don't fund those expenses through a tax-exempt account. You will be issued a credit card, like a VISA or something, that will only work to purchase medical stuff at the pharmacies..

swidd · 08-25-2010, 05:07 PM

Oh, and lots of offices will turn you away if you are not in-network. The doctors office handles all paperwork filings with in-network insurance companies, i.e. they verify benefits, calculate and let you pay your portion (a co-pay or 20% usually) during your visit or send you a bill later, and charges the insurance company for you - you don't need to do anything.

With out-of-network providers, depending on the competency or mood of the desk staff, you may have to pay the entire cost (100%) of a visit, blood test etc, and then submit the receipt with a detailed claims form, and wait for several weeks/hope that they approve the claim - and if they don't, you're shitfaced or have to suffer through months of appeals, dealing with non-existent customer service etc.

The insurance provider you go with will have a website with a list of doctors, and any of the major companies have tools that let you choose what illness you have, what procedure you need, see what it will cost, and show you a list of providers close to you.

08-19-2010, 10:15 AM	#1
jamal1984 The Beautification of Car View User's Garage Drives: Toyota Yaris S Join Date: Aug 2006 Location: Georgia, USA Posts: 967	Health Care Insurance? I'm 26 thinking of get a health care insurance before something really happen. Newbie to this, don't know what to look for. Visited healthcare.gov but can't find much. Visited a few website and here is what i found. Premium $187 a month with Calendar Year Deductible $1500. What is Deductible and in network, out network?... What am i look for? Thank you

08-19-2010, 01:00 PM	#4
DevilGirl Drives: 09 3dr LB MT Join Date: Aug 2009 Location: Lehigh Valley, PA Posts: 681	I would agree with BBPliftback on the in/out network definition. As far as the deductible part though, slightly better explanation, with example. Say you get sick and you go to the doctor's office. Your insurance will pay a portion of the office visit bill, and you pay the "co-insurance" amount (typically between $15 and $45, depending on the insurance plan). This co-insurance amount goes against your yearly deductible. So, for instance, you go to the doc ($25 co-insurance office visit), they say you need to see a specialist ($45 co-insurance office visit for specialist), and you are then told you need to have surgery. The surgery involves a pre-op appt with the anesthesiologist (another $45 co-ins office visit for specialist), as well as the hospital stay, and various other related charges. The insurance will pay the bulk of the cost, after your deductible is satisfied. So in this case, you paid out $115 in co-ins for office visits. The deductible is $1500.00. This leaves $1385.00 for your deductible. The total cost of the surgery (hostpital, surgeon, anesthesiologist) is $15,000. Out of the surgery cost, you pay $1385, which is the remainder of your deductible. So there is still $13615 that the hospital, surgeon, and anesthesiologist are looking to receive. The insurance company would pay either the whole amount, or an agreed amount and the hospital/surgeon/anesthesiologist will write-off the remainder (frequently happens). I know this from experience, as I had surgery in 2008, and only had to pay approximately $1000 out of the total $17,000 cost, due to my deductible. __________________ 2009 3dr LB MT Meteorite Metalic. Car bought 8/7/09. Now over 89k miles of trouble free driving, other than user error!!

08-19-2010, 12:23 PM	#2
2009BBPliftback Drives: 2009 Yaris LB in Blazing blue Join Date: May 2009 Location: Western PA (Franklin) Posts: 237	I work in healthcare dealing with insurances on a daily basis. "In network" is when you use selected facilities/doctors that have a contract with your insurance company. "out of network" is just the opposite when you use out of network your benefits (depending on the policy) they will pay at a much lower rate than if you use "in network". The Deductible is what you pay out of pocket before your benefits kick in. Hope this helps somewhat.

08-25-2010, 03:30 PM	#6
torontoo Banned Drives: ford Join Date: Aug 2010 Location: st.louis Posts: 1	Hello, Yes you are right we have to take insurance. this will really help in future and at that time you will think that you did a right thing. thanks!! _________________ TurboFire Workout for cheap

08-25-2010, 04:59 PM	#7
swidd Drives: Yaris HB Join Date: Jul 2007 Location: Central Alabama, GOD BLESS AMERICA Posts: 755	At age 26 you should be able to do better than $187/month. Around here, a single hospital/doctor network runs the entire city, like pretty much a monopoly, and their plans start at $60/month for the highest deductible/worst coverage, and run $120 for a reasonable plan. You have to assume that you can flip $1500 over in an instance if you have an accident, lose your job, become unable to walk and need a wheelchair, hospital bed at home, a nurse, girlfriend to quit her job to stay with you all day long to help. If you don't have $1500 laying around to pay a hospital if you get injured, go with a lower deductible... Or buy short term and long term disability insurance, and look into plans which let you pre-pay the first $1000 or entire deductible. Also look into a health savings account, through which you can fund medical expenses (prescription pills, co-pays (the deductible)) through a tax-exempt account that you fund through pre-tax payroll deductions. If you have any recurring medical expenses, or foresee having any minor issues at all, it is your loss if you don't fund those expenses through a tax-exempt account. You will be issued a credit card, like a VISA or something, that will only work to purchase medical stuff at the pharmacies..

08-25-2010, 05:07 PM	#8
swidd Drives: Yaris HB Join Date: Jul 2007 Location: Central Alabama, GOD BLESS AMERICA Posts: 755	Oh, and lots of offices will turn you away if you are not in-network. The doctors office handles all paperwork filings with in-network insurance companies, i.e. they verify benefits, calculate and let you pay your portion (a co-pay or 20% usually) during your visit or send you a bill later, and charges the insurance company for you - you don't need to do anything. With out-of-network providers, depending on the competency or mood of the desk staff, you may have to pay the entire cost (100%) of a visit, blood test etc, and then submit the receipt with a detailed claims form, and wait for several weeks/hope that they approve the claim - and if they don't, you're shitfaced or have to suffer through months of appeals, dealing with non-existent customer service etc. The insurance provider you go with will have a website with a list of doctors, and any of the major companies have tools that let you choose what illness you have, what procedure you need, see what it will cost, and show you a list of providers close to you.