Your Health Insurance Deductible

I have excellent health insurance, but I’ve found myself arguing with doctors’ office staff about what I am supposed to pay for services.  At first I thought it was just one greedy doctor’s office, but this has happened four times in the last two years and I now see a pattern.  The pattern shows that doctors’ offices are getting wrong information from UnitedHealthcare when they check my insurance.

“Your plan has a $300 deductible, so hand over your credit card to pay for the full cost of the test we administered” says the bill collector at the front desk of the doctor’s office.

My response: “My card says I have a $40 co-pay to see a specialist and I do not have a $300 deductible in my plan.”

Front desk person at another office:  “The doctor did a diagnostic test, so that will come under your deductible.”

Me:  “That is wrong.  Where are you getting this incorrect information?”

Front desk person:  “From your insurance company.  See right here on this printout, it says your plan has a $300 deductible.

Me:  “I will pay the deductible, but I’m getting my money back because that deductible does not apply to a doctor’s office visit and tests done in the doctor’s office.”

Front desk person:  “Everybody has a deductible now.”

What is your health insurance deductible?

Most health insurance plans have a deductible, ranging from a few hundred dollars to the maximum $6,300.  But many plans (including large employer plans) have co-pays for office visits, lab tests, and even outpatient surgery.  This is also the case with many under-65 individual Gold and Platinum plans.

I have an excellent health insurance plan through my spouse who works for Southwest Airlines.  Southwest provides awesome health insurance for its 40,000 employees and their families.  So lucky me!  But I still have hassles with my health insurance.

Yesterday I walked out of an optometrist’s office when they told me I would have to pay for the test to assess my cataracts.  They showed me a printout that said my plan has a $300 deductible – but I know the deductible only applies to outpatient surgery, or if I am admitted to a hospital.  But the doctor’s office didn’t believe me because they had a printout with the $300 deductible on it.  The printout did not clarify the deductible and to which services it applies.  The office staff assumed it applied to everything – even though my UnitedHealthcare card says I have a $40 co-pay for a specialist.

This incident got me thinking back to three other doctor visits and debates I had with front desk staff about my co-pay and my deductible.  I realized the doctor’s staff check my health insurance status and….. they are getting wrong information  over and over again!

Checking health insurance status is done by computer and UnitedHealthcare is providing wrong, or misleading information about my plan.

I sure hope my clients have not had similar run-ins with doctors’ office staff as they try to use their health insurance.

I’ve signed up people (under 65) with individual health insurance and I have encouraged them to get plans that had co-pays for doctor visits.  But those plans also have deductibles for major services like outpatient surgery.  I wonder if my clients have run into the same problems I have experienced.

Medicare Advantage plans do not have deductibles, so this is not an issue for my older clients.  Thank goodness!

Doctor office staff deal with dozens of insurance plans.  Each plan has a different deductible, different rules for what comes under the deductible, and what is covered by set co-pays.  It would seem to me that a billion dollar company like UnitedHealthcare would have a better system for explaining a person’s health insurance plan to busy medical staff.

I have awesome heath insurance, but I did not get the service I expected because the doctor’s office did not understand my plan.  They checked with United, but the info they had was not clear, so I ended up walking out in frustration.   And in an earlier visit to an ENT  office where they demanded I pay for a hearing test, I eventually got that money back because my deductible did not apply to that service that was covered by my office co-pay.

Why is health insurance so  complicated??  Because we have a stupid, inefficient – and expensive system!



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