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Venting!! Stupid Insurance!!

post #1 of 17
Thread Starter 
Well, first of all, I am not sure if any of you know what is going on with my husband..he had a heat stroke a couple weeks ago, and has been referred to see a nuerologist(sp?), but our deductable is $500 before insurance starts to kick in....then they will pay for 80% of everything else..well, he was suppose to go in today for an MRI, but the doctors office needed $126 upfront, but we don't have that money....I am trying to be positive about this thinking that when our tax return comes, we can use it for our deductable, but until then,he can't get his MRI done......doens't this sound outragous to you all?? I just have never have heard of the deducatable being so high, but who knows?? uugghhh
post #2 of 17
Most insurances have a deductible of some sort, and the amount usually depends on what type of policy you have. Normally the more you pay out of your pocket for your monthly premium, the lower your deductible is. I would guess that you don't pay much yourself out of your pocket, your employer is probably footing the majority of the bill, therefore you have high deductible.

Just as a comparison, our deductible is $250 for anything hospital related, and then the rest is covered 100%. Anything office related is $20 copay, and then 100% covered. We pay a large amount each week though, so in the end its all a wash I would guess.
post #3 of 17
Thread Starter 
office visits are only $10.00, but for MRI, or something more extravagant like that, you have to pay an amount of the deductable which we do not have....hubby's insurance takes a big chunk out of his check every week as well, so I guess that is why I am not understanding why the deducatable is so high....I dunno...**sigh**
post #4 of 17
Well, let me ask you this. How much do you pay weekly for coverage? For the coverage I mentioned that we have ( a family of 4 by the way) we pay $100 per week. You should be able to base yours according to that.
post #5 of 17
Thread Starter 
I'll have to go find one of hubby's check stubs and it will show..let me go see
post #6 of 17
Thread Starter 
it shows $75.75 a week taken out each week sooo...
post #7 of 17
I don't know what to tell you. Perhaps contact your employer to find out if there is a different plan that doesn't have such a high deductible, and one that covers 100% instead of just 80%. You'll never know unless you inquire, so get on that phone!

post #8 of 17
I've had to have an MRI pretty much each year since I started to have seizures and they've never told me anything like that! That's silly!
I have insurance from work that pays almost 70% (i think) of my doctors bills. and they even cover MRI's. I've never had to pay upfront to get an MRI thoughif I did, well there wouldn't have been any since I don't carry money with me to the hospital and I don't carry a purse there either.I think you better contact your insurnace agent and ask him (her) what the heck is going on. Maybe they can help you get one and you won't have to pay upfront!
post #9 of 17
Yeah, I had one of those before I quit my first job in San Diego. I ended up having to work out a payment plan with my provider because my doctor told them they had to do all the stuff for me (they're an HMO that's actually really good).

Now I'm back in San Diego and this company has that same stupid insurance so I stayed with hubby's (government provided).
post #10 of 17
I am appalled that your doctor demanded that money up front when your husband is in need of care! That's awful.

My health insurance has a pretty high deductible even though I pay $86/week just for me, but the doctors were always willing to work out payments. The only exception was when I had outpatient surgery last winter-the hospital wanted their portion up front.

Can you talk to the office about setting up a payment plan?

(Universal health care....where are you?)
post #11 of 17
Did he have the heat stroke at work? I'm sorry I can't remember. I read your thread before, but I don't remember if it was at work or not. Anyway, if he had it at work, shouldn't be up to his work to pay for everything, the MRI and stuff?
post #12 of 17
When I had my MRI done a couple years ago, I didn't have to pay upfront. That just sounds odd to me. Is there anyway you could borrow the money from someone or use a credit card? I know that it sucks having to borrow from someone or put a large amount on credit, but if push comes to shove you might have to do that.

Usually Hospitals are really good about setting up payment plans unless you're credit is really bad.

Sorry I'm not much help, but I do wish you guys the best of luck! Please keep us posted on your hubby, ok?
post #13 of 17
That's right if he had the heat stroke at work they are responcible for the whole bill.
post #14 of 17
It didn't happen at work...
post #15 of 17
Originally posted by HopeHacker
Did he have the heat stroke at work? I'm sorry I can't remember. I read your thread before, but I don't remember if it was at work or not. Anyway, if he had it at work, shouldn't be up to his work to pay for everything, the MRI and stuff?

That's a great point. If this happened on the job, Worker's Comp should be paying for EVERYTHING!

As to the coverage vs. the premium, if hubby is only paying $75/paycheck for self, wife, and 4 kids, it's quite possible that the deductible is very high. It seems like an awfully low premium for that many people.
post #16 of 17
If you were paying for an MRI w/o insurance (at least here in NYC) it could be anywhere from $800 to $1200 for the procedure. It's an expensive procedure because the cost of the MRI machine and its special lead-lined suite is very high. (They need the lead so the magnet in the machine doesn't start attracting nearby metal!) Your coinsurance may be based on a percentage of charges, and if it's 15% to 20%, it will be at least the amount you were quoted.If it's the deductible they are referring to, you must have that amount of $$ left on it. The fee they get for the MRI will definitely be greater than the $125, so that amount would be your responsibility under the plan.

Maybe you should call the neurologist, and ask him to call the radiology place that they sent you to, and ask them to work out a time payment plan? If that MD thought he needed one, and he couldn't get one because of not having $$ to pay the deductible in full, it's not going to look very good if (heaven forbid) something happened to your husband. Or, maybe he can refer you to a different radiology group which is more flexible. The problem is that any radiology procedure like this that is not ordered in an emergency room, is considered elective and they do have the right generally to require up front payment before providing the service.
post #17 of 17
That is outrageous! I thought hospitals couldn't refuse medical care because of someone's inability to pay?? Was it a private hospital?
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