fandomsecrets | [ SECRET POST #2938 ]

[ SECRET POST #2938 ]

⌈ Secret Post #2938 ⌋

Warning: Some secrets are NOT worksafe and may contain SPOILERS.

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02.

[Constantine]

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03.

[Dragon Age]

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04.

[Merlin]

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[Pokemon]

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[The Americans]

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[Doctor Who]

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[Twisted Toyfare]

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09.

[Black Books]

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[World of Warcraft]

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Flat | Top-Level Comments Only

Can someone explain how those work? If my deductible is $1500 and my monthly insurance costs $200, does that mean my insurance does not cover anything until 8 months into the year (8x200=1600)?

Related ^ Is it worth the $20 extra a month to have a $500 deductible vs a $1500?

This is probably related to how often you go to the doctor.

I, for example, very very rarely see doctors so it's not worth it to pay that extra $20 a month. I'm better off setting that money aside in an emergency fund that way if I do need it, I'll have it and it can make up the difference between a $1500 deductible versus a $500 one.

This is what I do too. If you only go to the doctor for preventative care and occasional small things, the $20 probably won't end up being worth it.

When I was between jobs and had to get my own insurance (my previous employer was too small for COBRA), I made a spreadsheet of various plans on Healthcare.gov in the range I figured I wanted. I put down how much I'd be paying in premiums, what the detuctibe was, out-of-pocket maximums, co-pays (if applicable), and other info like drug plans. I calculated the absolute maximum I'd pay in a year for each plan and the "realistic" amount I'd be likely to pay in a typical year (I rarely need to go to the doctor outside of routine stuff). I was able to discount a lot of plans right away because they cost more without offering more or didn't have things I wanted.

It came down to two plans: one that had a lower maximum possible cost but lower typical cost and one that had a lower typical cost but higher maximum cost. I chose the latter, because, again, I'm not likely to exceed the estimated typical cost by much but I could still manage the maximum cost if it came to that.

A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim. What this means, from what I understand, is that you are responsible for your bills up to $1500 and then the insurance will kick in and cover anything higher than that.

Someone correct me if I'm wrong, but that's how I understand it.

This is from Blue Cross Blue Shield's website:

Deductible

A deductible is the amount you pay for health care services before your health insurance begins to pay.
Let's say your plan's deductible is $1,500. That means for most services, you'll pay 100 percent of your medical and pharmacy bills until the amount you pay reaches $1,500. After that, you share the cost with your plan by paying coinsurance and copays.

Random anon here,

thanks for that explanation. I want to work in health insurance, so your explanation has helped...

This is correct, anon. I worked in medical billing and health insurance shit for a while.

A deductible is what you have to pay before the insurance kicks in. For instance, say I break my leg. Until I pay $1500, insurance would cover ZILCH. Your monthly insurance costs comes ON TOP of that.

Is it worth the $20 extra a month to have a $500 deductible vs a $1500?

In my opinion, yes. Because if you are paying $220 a month in healthcare, the larger amount you're paying is still less than the difference in deductible. It's a better deal overall, in my opinion.

Of course, I'm disabled so can't afford to go without healthcare for more than a few weeks.

Feel free to ask more, anon! I'm actually kinda good at this stuff! (And it's a work skill I never thought would be applicable to my real life but OH HO HO was I wrong!)

I'm the anon looking to work in health insurance.

How was your experience in that line of work? Besides deductibles, what were some important things you learned?

Sorry to hi-jack your thread, OP!

Well, first thing's first, I kinda worked in a weird way. I worked in a DME facility (that is, we made orthopedic shoes for people with diabetes, plantar faciitis, polio, Hansen's Disease, etc.) as a general purpose paper monkey. This meant that I handled the insurance claims (a LOT of Medicare), called up doctors to nag them about paperwork, called up insurance to nag THEM about paperwork, and dealt with chasing down unpaid claims.

So I was not a traditional worker in healthcare. I didn't get benefits, and I got paid $11 an hour at the top of my game.

That said, I actually kinda liked it, before my health shat the bed. Well, not the nagging for paperwork or money, but chasing down claims felt like a kind of digital archaeology. I felt like I was solving mysteries. And of course, in theory I was helping people.

However, I DID sometimes have shitty things happen. A miscommunication causing a very, very ill woman in the hospital to have a huge bill she couldn't pay, because she thought her insurance would pay and we thought SHE would pay. Tons of paperwork fail. At times, I was privy to extremely private medical information that was none of my business, that was totally irrelevant to the care they needed, PURELY to satisfy a new bullshit insurance requirement.

So it was really conflicting, and I really had some times where I wondered whether I was doing the right thing. I couldn't just dismiss these people as numbers on a spreadsheet; they were people I had to call up, people who were in the hospital, people who were sick and scared and sometimes dying.

I tried to be as good as I could be, but I'm honestly kind of glad I'm out of the business. I just had too much ability to ruin someone's life.

Things I Learned:
- How to read an insurance bill (SO USEFUL)
- How to get a straight answer from an insurance company (SO USEFUL)
- What all those things in your insurance manual MEAN, and how to gauge what insurance is best for you (OH GOD SO USEFUL)
- How to contest an insurance claim if something goes wrong (YOU HAVE NO IDEA OMG THANK YOU WORKPLACE)
- How to file an insurance claim on paper by myself, if necessary (haven't had to use this yet, but still, at least I CAN!)

Thank you so much!

I want to go into healthcare (become an NP, eventually open up my own clinic) and I want to know how to best serve my patients, and I feel that it very much includes helping them with insurance (or at least having some knowledge of it).

Knowing that I could (in theory) help someone not worry about their health costs (I know it's insanely expensive, I saw how much my insurance covers, it feels like I'm essentially paying 2% of what I technically owe) is something I look forward to. (A small part of me feels like a renegade, as if I'm going to go undercover in order to take down the insurance companies that aren't helpful, but I feel like that perspective isn't exactly understanding of ALL of the aspects of health insurance, which I'm guessing I hope I'll learn?). Thanks again!

No prob, Nurse!Anon!

Yeah, insurance be COMPLICATED. I mean, I worked doing it, and it STILL got to points where I misunderstood shit. That WILL happen, no matter how good you are, because health insurance is FIENDISHLY complicated. I've had cases where people had three different insurance companies, and they weren't sure which one was primary, I've had cases where percentages were more confusing than initially appeared.

So there WILL be cases where you will end up with charges you THOUGHT the company would pay and they won't. And you'll have to make judgment calls about what costs to eat, and what to stick your patients with. It's tough.

Even EXPLAINING healthcare can be really difficult, especially if you're running a medical practice on top of it. Honestly, you would probably be best-served hiring someone to specifically handle your billing, unless you're doing an extremely small practice. Because at this little orthopedic shoe shop, I was basically employed for 30 hours a week to handle phones and insurance shit. And it kept me busy too!

Ha, well now I know (somewhat) what to look forward to! (Also, not a nurse yet, but I'm on my way!)

Basically it means you have to pay $1500 worth of doctor/hospital bills before the insurance will pay anything. How fast you meet your deductible depends on how often you go to the doctor and/or how serious whatever you're going there for is. If you have to get a surgery, you're going to meet it quick, but if you hardly ever get sick and just have maybe a couple office visits a year, you're never going to meet it before it starts over the next year.

Premiums don't count towards your deductible.

Basically your deductible has little to do with your monthly payment other than that higher deductibles often have lower monthly payments. Deductible is what you pay out of pocket before insurance kicks in. Most insurance plans, even high deductible ones, will cover certain things in full -- preventative care like annual physicals will often just have a co-pay and drugs are usually partially covered if they meet certain criteria but things like allergy shots, specialist visits, trips to the hospital, etc. usually aren't. So say you get allergy shots and you need a new vial, which costs $200. You have to pay that $200, but it's subtracted from your deductible which would now be down to $1300 (1500-200 = 1300). Now, once you've just hit your deductible for the year if you need that vial again, this time insurance would cover it and you pay considerably less to nothing. If you get sick a lot or tend to need care that's unlikely to be covered, the lower deductible may be worth it to you. Basically is it going to save you more money in the long run to pay more for your insurance and ultimately less for medical care, or pay less for insurance but more for medical stuff.

Actually, annual physicals should be free now. The last one I had was.

I'm a dumbass and posted in the wrong part of the thread. Let's try again...

A deductible is what you have to pay before the insurance kicks in. For instance, say I break my leg. Until I pay $1500, insurance would cover ZILCH. Your monthly insurance costs comes ON TOP of that.

Is it worth the $20 extra a month to have a $500 deductible vs a $1500?

In my opinion, yes. Because if you are paying $220 a month in healthcare, the larger amount you're paying is still less than the difference in deductible. It's a better deal overall, in my opinion.

Of course, I'm disabled so can't afford to go without healthcare for more than a few weeks.

Feel free to ask more, anon! I'm actually kinda good at this stuff! (And it's a work skill I never thought would be applicable to my real life but OH HO HO was I wrong!)

I only went to the doctor like...twice last year. Both for routine/preventative stuff.

Ah. In that case, higher deductible might be worth it for you. I'm in care at least once a week, and probably will be for at least the next ten years, so obviously my priorities are way different than yours.

Flat | Top-Level Comments Only

[ SECRET POST #2938 ]

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