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Insurance guru's educate me

Discussion in 'The Lounge' started by az-k5, Nov 3, 2005.

  1. az-k5

    az-k5 1/2 ton status

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    Okay, well I am turning 23 and my dads insurance company is going to boot me. Fulltime student or not. I need to get some sort of private coverage. I looked around for quick quotes and don't have a clue what I am looking at. This kinda decision is scary to me. I don't like doctors (lucky if I see mine once a year). But I do need insurance. They offer a plan at my work, but it isn't worth beans (and being part time makes it $$ to get).

    What do all of the terms mean??

    clicky for quick quote site I found <- this is where I started to get confused.

    How do I know what I pay for perscriptions? Doctors visits?

    Help :confused: :confused: :bow:

    Thanx
     
  2. Skigirl

    Skigirl 1/2 ton status

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    A co-pay means the portion of the medical bill that you have to pay. Usually this is for services at a doctor's office. Some insurance plans have a set amount you pay (like $20 for the visit, no matter how much the actual bill is) and other plans make you pay a percentage of the allowable fee (the allowable fee is the amount of money the doctor agrees to accept for each thing he does, which is less than the fee he charges. The insurance company tells the doctor how much each thing he does will be paid.) So in the plans you see where it says the co-pay is 20%, you pay 20% of the bill for the medical care. If the insurance company would pay the doctor $100 for what he did, you'd pay $20.

    A deductible is an amount of money you have to pay out of your pocket for medical care before the insurance company will pay anything. So where it says the deductible is $5000, that is how much you'd need to pay each year before the insurance will kick in any money.

    In-network means that you will see doctors that are part of their plan (these doctors are called participating providers, meaning that the doctor has a contract with the insurance company to accept the insurance company's fees). In order to get doctors to agree to be a participating provider, the insurance company tells the people it insures that they will cover more of the doctor or hospital fee if the patient sees one of the doctors in their network. Out of network means that the doctor doesn't have a contract with the insurance company, so is not a particiapting provider. the insurance company won't cover as much of the bill as it would with a participating provider.

    If there is a prescription coverage, the plan will specifically mention it and will give you a flat co-pay amount or co-pay percentage just like for your overall coverage. G means the amount you will have to pay for generic forms of a prescribed medication, B means the amount or percentage you will pay for a brand named drug. For example G$15 means that you would pay $15 of the cost of the prescription for a generic form of the drug. Generic drugs can be different than brand names (tho they don't admit it) so sometimes doctors will insist on the brand name version of a medication. Brand names cost more, so the co-payment for you is more. Sometimes there isn't a generic brand on the market.

    There are very few decent insurance plans, and even fewer that are affordable. You are young enough that, unless you have some chronic illness or need expensive prescription drugs (and there are inexpensive prescription drug plans that can provide some discounts) you would be better off IMHO to get an insurance plan that covers catastrophic occurrences. Typically a health incident resulting in hospitalization averages $15,000. Of course hospital bills can be hundreds of thousands of dollars too.



    So find a plan that has a deductible you can handle if you stretched it (or could borrow the money to cover) and get a catastrophic coverage plan - hospitalization and maybe ambulance coverage and ER coverage.
    Hope this helps.
     
    Last edited: Nov 4, 2005
  3. az-k5

    az-k5 1/2 ton status

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    That about sums up all of my questions. I do have azhma (sp) but inhalers are cheap (and I can get them from mexico if need). I am more worried about catostrophic events ($$$$ ER bills) and that whole "laps of coverage" issue.
     
  4. Skigirl

    Skigirl 1/2 ton status

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    Then you are on the right track. Once you find something you think you like, talk to the insurance rep at length. And review the documents or have someone who knows insurance review them with or for you. The billing department of a local hospital or your family doc could probably tell you the pros and cons of what you are considering. If you can't find anyone, I will help you.
     

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