First time medical insurance. Questions, I have

Hey all.

For the first time in my 45 years, l finally have medical ins..

And I know nothing about it.
I guess the main 2 questions I have is this (it's UnitedHealthCare, btw).

2500 deductible.

1. If I get some procedure done (first time using card) and it's $500, do I have to pay the whole 500 since deductible is still $0 paid by me or does United pay a bit, I pay the rest and "the rest" is toward deductible?

2. If I can't pay my portion in any point in time, pre or post deductible, must I stop going to the dr/hospital until it's all current?

3. If a quote of what the insurance says they'll pay is very littoe, do I just have to suck it up and accept it or can I fight it to get them to pay more?

Oh yeah, and is insurance unlimited? I have rheumatoid arthritis and no doubt it'll cost a ton.

Does insurance literally.... Run out like say dental does?

a reply to: sarra1833


There are so many variables with insurance that every situation will be different.
Office visits will have a co-pay at the time of the visit. Usually $20-$25.
Even a specialist will have a co-pay.

My coverage is an 80-20 type.
I pay 20% of the bill until I reach my deductible.

As for question 2, you will be billed later so you should have no trouble getting treatment.

I would suggest you call the number for customer service on the back of your insurance card.
They will be able to answer your questions more accurately.

Hello,

1: generally speaking you will have to pay the cost of the procedure. United will pay nothing until your yearly deductible of 2,500 is met. If you have office visit coverage with just a copay- then united will pay for the cost of the visit(dr. Talking to you) only, no other charges or procedures will be covered until deductible is met. If you are going to have a scheduled procedure done, ask the Dr. office what billing codes they will be using, then you can call united to ask if those codes are covered and ask what is the negotiated amount united allows for each billing code. You are only responsible for the negotiated amount that united allows- A Dr. can charge whatever they want for a procedure but, you are only responsible for the amount united has negotiated and allows. For example, dr. Charges 500.00 for a procedure, united has negotiated the fee to be 150.00.- you should only pay 150.00 to the doctor- sometimes the dr. Will be sneaky and try to make you pay the whole 500.00- tell them no, they need to write off the remaining 350.00

United will send you a copy of the charges and what you are responsible for paying after they process the claim. I am pretty sure you can view online too.

2: find a dr. That will allow payments- there are quite a few. make sure the doctor in in network for your plan!!!! Hospitals will allow payments as well.

3: you can always call them and inquire. I have always found united to be one of the top insurers, they don't have many errors and don't play games. I have united also. I also worked in a doctors office working as insurance billing department.

originally posted by: sarra1833
Hey all.

For the first time in my 45 years, l finally have medical ins..

And I know nothing about it.
I guess the main 2 questions I have is this (it's UnitedHealthCare, btw).

2500 deductible.

1. If I get some procedure done (first time using card) and it's $500, do I have to pay the whole 500 since deductible is still $0 paid by me or does United pay a bit, I pay the rest and "the rest" is toward deductible?

Depends on the plan (PPO, HSP, etc.), but generally, yes, you will pay for procedures up to your deductible amount, then you will pay the percentage described in your plan after that.

2. If I can't pay my portion in any point in time, pre or post deductible, must I stop going to the dr/hospital until it's all current?

In a word, no. You can still continue to seek healthcare as long as you pay your premiums, but that doesn't mean you don't have to pay the bills, or that providers won't turn you over to collections and wreck your credit.

3. If a quote of what the insurance says they'll pay is very littoe, do I just have to suck it up and accept it or can I fight it to get them to pay more?

You'll pretty much have to suck it up. Negotiating with insurance companies is next to impossible. In fact, you've got a better chance negotiating with the provider than you do the insurance company. The insurance company wasn't there, you were. That said, your insurance company IS supposed to fight on your behalf to remove frivolous charges and the like. Unfortunately though, this whole game is a self-fulfilling prophecy...providers jack up their costs because they know insurance companies are going to negotiate them down, then both them get more creative to the point it takes attorneys to sort it out. Providers know how much they can push this before you'll get an attorney, and they'll stop just short of this amount. They'll both also waste as much time as humanly possible giving you the run-around, so unless you have all day for weeks at a time to deal with all the being put on hold, transferred to someone else, etc then it's not worth the time usually. They know this too and employ these tactics with absolute brutal indifference.

a reply to: sarra1833

Insurance does have a cap, but it's usually pretty large. You won't hit the cap with simple stuff like colds and a broken toe, but something like cancer treatment can easily reach the caps.

Oh, and many insurances have something known as a 'lifetime benefit' (or something similar to that) which is the maximum they will ever pay out for you in your lifetime.

Honestly, it depends on how good the insurance is. The application of a deductible can different for various plans and for various procedures. We have a deductible, but it only has to do with major procedures, not prescriptions, office visits, etc. That's all co-pay. And even with major procedures we don't pay the full deductible. For example, my wife had two vertebrae bolted together, and our total out of pocket was $600, even though our yearly deductible is $2,500.