While looking for a health insurance, I got a health insurance quote that has rates for an in-network health care provider. As indicated, an individual insurance has a $3000 deductible and $5000 maximum out-of-pocket amount. For a family insurance, however, a deductible amount of $6000 and a maximum out-of-pocket of $10000 is given. In addition to these, terms of a co-pay of 70% that includes office visits, laboratories, and specialists are also given. Furthermore, information regarding hospital coverage is also specified as $3000 for an in-network hospital and $6000 for an out-of-network hospital. I want to know for sure what these rates from the health insurance quote means. Let’s say I took an individual health insurance plan and have been admitted in an insurance affiliated hospital for 10 days and was billed $20000 for this service. How then does my health insurance work on this? How about if the same hospital has $450 for 5 days admittance after deductible policy, who pays for the bill if the 5 days stay exceeded? How much would it cost? Is this going to be a 100% insurance coverage or a co-insurance share?
It is also specified in your health insurance quote that medical services such as doctor office visits, and use of laboratories and specialists, you are required to a 70% share to its total cost of up to $5000, which is your allocated out-of-pocket maximum. If the copay exceeds the out-of-pocket maximum amount, then the insurance pays the total amount of the service for the calendar year. You may also check the health insurance quote whether the deductible is also covered in your out-of- pocket maximum. If it is, then these rates may change. Regarding the scenario you have mentioned, if you are given a 5-day deductible then the first five days of your medical care is at your expense. However, if you have 5-day limited coverage, then you will pay for every day beyond five days of your hospital stay. You may consult a local insurance agent to further explain how your health insurance quote works. Answer by general public - June 19, 2009 @ 5:25 pm No CommentsNo comments yet. Leave a comment |
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Based on the health insurance quote you’ve got, you fall on the individual health insurance rate that has coverage for an in-network healthcare provider. This means that you have to meet the $3000 deductible amount first before the health insurance start to cover for you on your hospital bill for a maximum of $3000. You will shoulder the amount beyond this cost.
