I have to meet the deductible first before the copay kicks in apparently. Which really sucks for someone like me who never goes to the hospital, ever.
You should have a few in-network providers that you do not have to pay the deductable. Deductable is only for out of network. Even if you go out of network and have a 400 deductable you will not be paying 400 bucks. You will pay the contracted rate which will be much less.
The lady at the doctor's office loaded me up with some misinformation then. I still don't like the 10% copay and 25% on prescriptions, but on the other hand I worry that I could be in danger of one day being in Batman Jones' position needing a medical procedure and getting shafted by the insurance company.
it's funny reading this thread...because i just watched 'sicko' like 2 hrs ago... seriously...move to france or UK... or even... CUBA!
that Dr. was probably out of your network. 10% copay is weird. Most of the time it is a flat rate not a %.
That sucks batman. Sorry you are having such a horrible ordeal. It is a real crapper that the accident and resulting injuries cause pain, then the frustration of dealing with sucky insurance at exactly the wrong time must be enough to make you go crazy. What BS. I hate it when a doctor who is caring for you knows what's best, but the inusrance somehow thinks they know better.
It's a flat rate for the HMO, but with the PPO (which is what I currently have) it's a percentage. That's my primary incentive for wanting to switch to the HMO.
If it really is a percentage I would find out what the cost is for an in network Dr. Mine is like 60 bucks contracted rate, I pay 20-25 copay but 10% would only be 6 bucks. I doubt any Dr. visit will be 250 dollars.
I really don't know the difference, but just for clarification I am in a PPO. FranchiseBlade: You're right that it's a major drag to deal with all of this on top of the pain, inconvenience and lost opportunities of the injury (I got a grant from the Swiss government to direct a play in Kosovo which was to be the subject of a documentary and due to the injury that opportunity was lost). But you know what REALLY sucks? Having an ******* like fmullegun stinking up my thread when he saw fit to make lameass jokes about the whole ordeal, calling me a pothead (I'm not), saying I was a leech on society for not having good enough insurance, suggesting I was lying about being overseas on business and laughing all the way. He is a major dick and a major troll and he was banned from D&D for his behavior. Now he's here trolling this thread.
Get well soon Batman. I hope you don't end up like this guy... Man Succumbs To 7-Year Battle With Health Insurance DENVER—After years of battling crippling premiums and agonizing deductibles, local resident Michael Haige finally succumbed this week to the health insurance policy that had ravaged his adult life. Haige, who had suffered from limited medical coverage for nearly a decade, passed away early Monday morning. According to sources, the 46-year-old was laid to rest at Fairplains cemetery, surrounded by friends, family members, and more than $300,000 of mounting debt. ... According to an independent study released last month by the Mayo Clinic, health insurance is the nation's No. 2 cause of death, claiming the lives of some 400,000 Americans each year. A silent killer, health insurance often strikes without warning, its harmful and profit-based policies avoiding detection until it is far too late. Although the cruel bureaucratic disorder does not discriminate, statistics have shown that senior citizens, young dependents, and those woefully underemployed are most at risk. "I can't tell you the number of patients I've had to deliver the bad news to over the years," said Haige's longtime family physician, Dr. Howard Silverman. "It's never easy to look someone in the eye and tell them it's going to have to be out-of-pocket. For most of these poor people, prayer is the only hope." ... http://www.theonion.com/content/news/man_succumbs_to_7_year_battle_with Our prayers will heal you.
For future reference, for all of your sakes... If you have an Aflac Personal Accident Indemnity policy, and you need a walking boot, that benefit alone is $125. The initial visit to the doctor (if done within 72 hours) would pay $120. The MRI or CT scan would pay out $250. The boot would be $125. If it was an open reduction (surgery) then it would pay about $1200 for that. $35 each follow-up and also a benefit for each licensed physical therapist visit. The average ambulance ride, needed blood, surgery for a broken leg claim (which is more common than you might think, due to car wrecks) is paying out around $4300... If you figure that your major medical deductible is around $2500... you can clearly see that you would be paid some overage. Aflac doesn't care about what you spend it on. Obviously, you'd reimburse yourself for the out of pocket medical expenses, deductibles, co-pays, etc... but pocket the $1800... go on a trip... pay the mortgage, whatever you want. pirc1, you certainly can get Aflac directly without going through work. We just auto draft it or set it up on a debit card or credit card monthly or quarterly... OR you can have me come in and present it to your work. The savings can be significant if it is done through payroll. I will tell you this for the sake of an example, and not knowing what industry code or (SIC) you fall under, but a direct Accident policy is $43.10 per month for an individual (that's a little over $10 a week on average) for ages 18 - 64... (That is the policy I'm referencing in the broken leg example above). Now if that same policy is selected through a W2 payroll group, where the premiums come out of your pay, you can get it for around half of that premium (about $5 per week), or even insure a individual, spouse and children for less than the individual direct cost (around $9 per week). If you could help me get a solid appointment to talk to the decision maker (owner, CFO, etc.) I would drive anywhere in the state to come show the company how easy it is to allow you to get it set up. I would just need to plan it in my calendar, as the schedule is filling up all the time! Owners love being the hero that gets the workforce affordable coverage that pays out cash! The owners also love the fact that it is 100% elected on by the employees, and does not cost the business anything. We even have ways of saving the business money in payroll taxes each year. It's really cool. JYD & Turbo, if you can send me an email to houtexfan@gmail.com I'll fire you out some basic policy info. Remember, we can get you covered WITHOUT going through your company, but it is an even better rate to go through payroll if possible. Many self-employed business owners can also qualify for group rates if they select 3 policies... there are some things we can do on a case-by-case basis. A new initiative called "Wingspan" just opened the door to several 1099 positions as well. The greatest news to all that are interested about payroll rates is this... It only takes 3 W2 employees, getting any 1 of the 14 different policies we offer to qualify as a payroll rate account. We're talking as much as 20-50% less premium on most policies. Just here in my area alone we have groups with as few as 3 employees, and as many as 13,000... and the 3 person group gets the same discount as the 13,000 group does. A brief list of what we offer to payroll accounts: short term disability term & whole life term to 25, whole life after (kids) accident (#1 purchased policy) cancer (#1 benefits payer - affiliated with MD Andersen and 56 other treatment facilities including Aflac Children's Cancer Center in Georgia) specified health event (heart attack, stroke, coma, kidney failure, etc.) hospital plans -pays benefit for hospital stays, per day long term care dental vision Direct policies are available on everything except disability (State of Texas rule), and vision (no rule, just is what it is). Remember, YOU pay for Aflac, NOT your company... and YOU spend the predetermined benefit amounts how YOU want to. It is designed to keep your life afloat while you face the set backs of accident or illness. I have already seen claims come through and help my clients, and I know Aflac stands behind their policies 100%. I even helped a lady get her wellness benefits paid for the past 10 years, that she'd forgotten to claim, or wasn't even aware she could get, to the tune of a cool $750 of "free" money. Yes, you read right... Aflac plans pay you for being healthy, too! Anyway, enough thread derailing, email me if you want to know more... sorry Batman. I do honestly wish I could have helped you out with a plan before all this happened to you. I do honestly pray you get better soon, and the insurance hassle gets easier to deal with. May you find favor with the claims department, man.
I've never actually attempted to see the pros and cons as far as price goes actually. It was a coworker's husband suggestion. Interesting info, thanks. (I dont know what goes on in the training there, but all Aflac representatives seem to be the most genuinely satisfied workers ever lol.)
I am actually in Indiana and work for a large university, so there is no way I can get you an appointment with the president as I am just a peon. Thanks for the info. On a side note, do you have a duck in your office?
Arbitrary? LOL You realize that insurance companies calculate benefits based on expected premiums paid, right? All carriers cap the rehab visits on the PPO side, whether it be at a number of rehab visits or to a max dollar benefit they'll pay. People are unhappy with it either way.
