Insurance
Our insurance policy is basically a major medical policy. My boss believes that we should each be responsible for the small stuff and use insurance for the big stuff. Besides, we all know that insurance is expensive, and this is a way he has found as the employer to be able to offer health insurance, and for us as the employees to afford to insure our families.
One cool thing is that the policy carries a $750 first dollar benefit. It simply states that each insured person has $750 to use each year for routine checkups, urgent care visits, etc. You cannot use it for any service that would be deemed diagnostic or on a service that is addressed elsewhere in the policy, like mammography.
I recently received the explanation of benefits for my annual physical and for The Boy's wellness exam, and on it his immunizations are not covered but will be applied to the deductible. Same goes for my exam, which was covered, but not the accompanying lab work.
What part of the immunizations would not be considered wellness? I am diligent so I carefully read the manual only to find that both of these services should be covered. I called, they agreed and resubmitted the claim. I got notice yesterday that they are now paid.
The chest x-ray will not be paid but will apply to our deductible because it is considered diagnostic.
I am left wondering how many people get the explanation of benefits and pay for things that should have been covered under their policy.
As an aside, the total fees for the two of us was $584.00. Does that seem high to anybody besides me? Bear in mind that we're up here in small town Montana, not a big city, and we seek our care in a small clinic. I really would like to see health care addressed in this next election, and not with a bunch of empty campaign promises.
Then again, are there any other kind?
One cool thing is that the policy carries a $750 first dollar benefit. It simply states that each insured person has $750 to use each year for routine checkups, urgent care visits, etc. You cannot use it for any service that would be deemed diagnostic or on a service that is addressed elsewhere in the policy, like mammography.
I recently received the explanation of benefits for my annual physical and for The Boy's wellness exam, and on it his immunizations are not covered but will be applied to the deductible. Same goes for my exam, which was covered, but not the accompanying lab work.
What part of the immunizations would not be considered wellness? I am diligent so I carefully read the manual only to find that both of these services should be covered. I called, they agreed and resubmitted the claim. I got notice yesterday that they are now paid.
The chest x-ray will not be paid but will apply to our deductible because it is considered diagnostic.
I am left wondering how many people get the explanation of benefits and pay for things that should have been covered under their policy.
As an aside, the total fees for the two of us was $584.00. Does that seem high to anybody besides me? Bear in mind that we're up here in small town Montana, not a big city, and we seek our care in a small clinic. I really would like to see health care addressed in this next election, and not with a bunch of empty campaign promises.
Then again, are there any other kind?
posted by Well-heeled mom @ 10:56 AM
1 Comments:
At 8:07 PM,
DD said…
1) Do you pay a portion of the premium for our insurance? Is it a self-funded policy?
2) Well child checkups are covered by my insurance, not the immunizations. I go to a "free-clinic" where I do pay voluntarily for reduced fee service (no overhead for facilities or doctor since they do it in a church office). Certain "immunizations" are actually voluntary and quite expensive (RSV shots are up to $1500 per shot and you must have 3 - usually for preemies) so that's why some insurances/respective policies do not cover that kind of service.
3) I don't recall what your exam was for, but if you emailed me privately I can give you a pretty close comparison $$ just for shits and giggles.
Medical expenses are high because Medicare and Medicaid don't pay close to what it costs to provide the services. Therefore private payers and private policy holders pick up the slack. No, it is not illegal as long as everyone is charged the same.
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