4 ms·

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit wou

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit would have been MUCH cheaper out of pocket for me.

lotsofpulp 6y ago
Then I don't know what definition of deductible your insurance company is using, but it doesn't match my experience with any insurer ever, health or otherwise.
- lostapathy 6y ago
  It's simple - I have a flat $500 copay for an "ER encounter" regardless of what they do in the ER. Just like you have a $40 or whatever copay for a regular doctor visit.
  - lotsofpulp 6y ago
    The deductible must be paid before copays come into play. If you have a $2,000 deductible, then you will pay whatever the insurance company has negotiated with the in network provider for the billing codes the provider bills, up to $2,000. After that, the copays amounts come into effect. https://www.investopedia.com/ask/answers/051415/what-difference-between-copay-and-deductible.asp https://www.investopedia.com/ask/answers/051415/what-differe...
    - lostapathy 6y ago
      No, that's not how it works. Most health insurance plans have a few services that are copay-limited even before you hit your deductible. i.e., the $40 for an office visit to your primary care doctor, $90 to see a specialist, and in my case $500 for the ER visit. Imaging and procedures are my problem from the start, up to the deductible though ... apparently unless they happen in the ER. Like I said way up-thread, the way it's structured puts the incentives in the wrong place for me. Had my two visits for ER and scans been in the opposite order, I would have been out of pocket the same total. Anyway - I'm done arguing with you. I know how my plan works and what I've paid this year, whether you believe me or not.

4 ms·

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit wou

by lostapathy 6y ago

lotsofpulp 6y ago
Then I don't know what definition of deductible your insurance company is using, but it doesn't match my experience with any insurer ever, health or otherwise.
- lostapathy 6y ago
  It's simple - I have a flat $500 copay for an "ER encounter" regardless of what they do in the ER. Just like you have a $40 or whatever copay for a regular doctor visit.
  - lotsofpulp 6y ago
    The deductible must be paid before copays come into play. If you have a $2,000 deductible, then you will pay whatever the insurance company has negotiated with the in network provider for the billing codes the provider bills, up to $2,000. After that, the copays amounts come into effect. https://www.investopedia.com/ask/answers/051415/what-difference-between-copay-and-deductible.asp https://www.investopedia.com/ask/answers/051415/what-differe...
    - lostapathy 6y ago
      No, that's not how it works. Most health insurance plans have a few services that are copay-limited even before you hit your deductible. i.e., the $40 for an office visit to your primary care doctor, $90 to see a specialist, and in my case $500 for the ER visit. Imaging and procedures are my problem from the start, up to the deductible though ... apparently unless they happen in the ER. Like I said way up-thread, the way it's structured puts the incentives in the wrong place for me. Had my two visits for ER and scans been in the opposite order, I would have been out of pocket the same total. Anyway - I'm done arguing with you. I know how my plan works and what I've paid this year, whether you believe me or not.