Confused about Insurance Deductable and how it works with co-pays and Rx's.

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78SilvAnniv
Regular Member


Date Joined Apr 2008
Total Posts : 289
   Posted 9/14/2008 9:16 PM (GMT -7)   
I've got a question about how deductables and co-pays work.
$500 medical deductable.
$250 hospitalization deductable.

I have a facility billing me for the medical deductable, minus three $30 co-pays that I've paid at the time of my appointments...which makes it appear that co-pays DO count towards lowering the deductable. I have since paid more co-pays to this facility and I am unclear how they are charging me for this deductable when I have used other facilities, making co-pays, and they (the other facilities) have not charged me for portions of the $500 deductable. Why should this facility get the entire deductable when I've patronized other facilities, too?  Don't the other facilities have a right to a piece of my deductable pie?  Also, if my co-pays for all doctors, facilities and Rx's total more than the deductable at the time they 'charged' me for it, am I still obligated to pay the full deductable amount?

I just don't see how that works.
I mean, I could better understand if at the 1st of the year I had to pay out-of-pocket for everything (full price) until I had reached $500 and then insurance kicked in...but this just seems so...arbitrary. This is the first time I've EVER been billed for a deductable! We've been with this insurance provider for 7+ years. I've been being seen at this particular facility (who is billing for the entire 2008 deductable) for almost 4 years.

I will be calling my Insurance provider tomorrow morning to see if they can explain it to me. Or maybe I should call our employer's Human Resources liason?

Does anyone have some insight or an explanation I could understand?
Heidi
I have the ability of single-minded determination and accurate project focu....Hey, look, a cat!
 
Crohn's and UC are pretty darn crappy, but if you can't laugh at yourself, you'll cry. 
I'd much rather laugh.
2001 Dx'd with UC.  No remission.  5/2008 surgery, removal of 6" of left side colon.  Dx changed to Crohn's.  Remission for 8-9wks after surgery, symptoms returning after resuming 6MP.


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 9/15/2008 9:36 AM (GMT -7)   
Heidi, co-pays normally don't count toward deductables, so I'm not sure why they are deducting your co-pays out of your deductable amount.  Normally, you have to pay the deductable on the first service (or services) you have done that year until you hit the $500.  So, if you went to several facilities early in the year, the bill you received from each of them should have shown that you owed some on your deductable until you paid your $500.  Not sure why one facility only is billing you for services provided throughout the year.  You should call your insurance company and then the billing department of the facility who is billing you that way. 

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


78SilvAnniv
Regular Member


Date Joined Apr 2008
Total Posts : 289
   Posted 9/15/2008 10:28 AM (GMT -7)   
Just came back from talking to HR and they were able to explain the statment in a way that I understood.
They advised that the first facilty to submit their claims is who the deductable would be paid to, not necessarily the first medical facility I visited.

Also, it appears this facility's receptionist staff were asking for $30 co-pays on my Remicade days, which should not have had a co-pay, and that is why those co-pays were put towards the deductable total.

So, while I understand that, I don't understand how I've never had to pay a deductable until now. Unless...it is because it hasn't been until recently that I've had any outpatient (remicade) procedures. OR, our insurance coverage states chemotherapy coverage is 100% AFTER the deductable is met. ...then I'm back again to why this facility charged me in 11/07 for the deductable when I began receiving chemo (remicade) in January of that year.

I'll still call this facility's billing department this afternoon and get it straightened out/paid.
I've got only good things to say about the HR department, they are GREAT people to have on your side and to explain things to you.
Heidi
I have the ability of single-minded determination and accurate project focu....Hey, look, a cat!
 
Crohn's and UC are pretty darn crappy, but if you can't laugh at yourself, you'll cry. 
I'd much rather laugh.
2001 Dx'd with UC.  No remission.  5/2008 surgery, removal of 6" of left side colon.  Dx changed to Crohn's.  Remission for 8-9wks after surgery, symptoms returning after resuming 6MP.

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