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I just signed up for health insurance, and I do not get it...?

So here's the issue I signed up for health insurance through my job, I never had insurance, I'm 19, male, and the insurance is PPO BCBS of Illinois. I really want to go to the doctor b/c of a pain I've had on my foot, but I don't get how my insurance coverage works. Do I have to pay the $1500 deductible before I go see a doctor, b/c if that's the case what is the benefit of having it and paying a biweekly premium? I could just easily use $1500 and pay the visit, and put the rest in a high yield saving account for future use of any health issues I have and I would be earning interest on that money... I called the insurance company and all they did was confuse me b/c I asked them same question I am posting, I even asked them where am I suppose to send this $1500 check they want, and they told me that I wasn't, to get an FHA or FSA account or something like that, I don't even know what that is, they told me to still show my insurance card even though I haven't paid this so called deductible... Like if I have a car and I get in a wreck my auto insurance is not going to touch my car until I give them the deductible... I also told them how am I going to risk going to some doctor and he charges me $300 dollars and they don't cover it, and I have to pick up the whole tab... They didn't give any worthwhile answers... I find this whole insurance thing very confusing, can someone actually explain it... Thank you!


Ok, I understand I know I need insurance that is why I got it, maybe I did not make myself clear or maybe I am the one that is not understanding, but who do I pay this deductible they ask for, im guessing not the insurance since they told me that I should not send in a $1500 check to them... B/c this how i am seeing it, i wont get a discounted price at any doctor vist, till i pay that deductible. so if my visit is $300 I will pay $300 with or without the insurance since i have not paid the deductible, eventually when i pay this deductible the discount or the perks of having this insurance will go into effect. is that correct?

4 Answers

  • Zarnev
    Lv 7
    7 years ago
    Favorite Answer

    First thing is you do not send any money in to pay the deductible. If you use medical services you'll pay the person or facility that provided those medical services. The way it works is the provider puts in a claim to the insurance company, the insurance company will reprice the service and send a notice to you and the provider. The provider will then bill you the repriced amount and you pay the repriced amount to the provider. The repriced amount that you pay is part of the deductible.

    So if the provider originally bills $1000 and the insurance company reprices it to $600 you pay the provider the $600 and now you only have $900 ($1500 - $600) left of the deductible to pay. If you do not use medical services for the rest of the year you don't have to pay that $900 to anyone.

    Second thing to do is to look at your paper work. If the paperwork says you have a co-pay for a doctor visit of $XX.xx that is the amount you pay when you go to the doctor, and it doesn't matter if you've paid anything toward the deductible or not.

    The real reason to have insurance is for the big things, not the little things. A $200 doctor charge is not going to hurt too bad and even paying the $1500 deductible is doable for most people, but a $200,000 hospital charge will hurt and with most people would result in bankruptcy.

    Source(s): Independent Ägent
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  • 7 years ago

    Yes, if the deductible is $1500 you have to spend that much during the year before you get coverage, so you may not need that. You should find a plan with lower deductible and higher premiums. If you dont have insurance and get sick or injured, how can you pay for it? Insurance is intended to cover you in case something happens which you dont know. All insurance has deductibles which you pay before they will chip in and they pay only 80% even then. You can take a risk and not buy insurance and go to any community clinic and see a doctor any time and pay cash. A doctor visit at a clinic will cost $50 to $100 depending on where you live. Thats whats wrong with private insurance practices.

    Under Obamacare, a lot of this changes next year. You can purchase your own insurance plan according to your needs and also get a good tax credit when you file your tax return. So maybe you should wait until the state insurance exchange is set up later this year.

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  • 7 years ago

    1. If you had no insurance for the last 63 days before you got this insurance, and you go to the doctor for something that was already wrong with you before you got this insurance, then you pay the same as if you did not have insurance. It does not count towards the deductible. Insurance does not cover or count any medical care during the first 6-18 months for anything that was already wrong with you before you first got insurance.

    2. You do not pay the deductible all at one time. Each time that you go to the doctor, you pay the doctor whatever the doctor charges ($300 in your example), until the amount you have paid for things that insurance covers equals the deductible. For example, if each trip to the doctor is $300, then you pay the doctor $300 five times, once on each of your first 5 visits. However, this only includes the visits that insurance covers; it does not include the ones for things that were already wrong with you before you got insurance.

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  • 7 years ago

    Insurance is not suppose to pay for every scrap and sniffle. If it did, no one except Bill Gates could afford it. It's there to keep you from going bankrupt for medical reasons.

    When you go to the doctor with insurance, you get discounted treatment. If it costs $300 to go to the doctor with no insurance, it might cost $200.

    There are some things that are included prior to meeting the deductible But typically the insurance won't pay until you meet the deductible.

    The insurance company should not have talked to you about an FSA, your company may not offer this type of plan.

    Let's talk about your foot:

    You go to the doctor, thinking you have tendonitis ~ only going to cost you $300 to get the cortisone shot and the doctors visits.

    What if you find out you have bone cancer ~ are you going to be able to cover the cost of treatment by putting money in a high yield savings account instead of having insurance (even I can't and I probably make 4x as much as you = I'm not being snotty I'm no longer 19 and don't get paid like most 19 year old).

    - this is exactly what happened to a 7th grade classmate of mine. Broke her arm during PE by the end of the day she was diagnosed with cancer.

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