Insurance deductible and being broke
June 14, 2015 2:10 PM   Subscribe

I have $475 left on my deductible. I already received bills this year for $841 dollars that I've haven't yet paid on. Do I have to pay all $841 or will I start getting coinsurance after I pay $475.

What it says on the tin. My real question I guess is, is the deductible retroactive? These claims are listed as 'processed' on my insurance tracker, so my heart says I'm screwed since I haven't been paying as I go. But my hope says that I really shouldn't have to pay more than the deductible is without coinsurance.

I did call the insurance company already but I'm not sure if I explained my question well so I want to see what the general consensus is before I call back and reword it.
posted by motioncityshakespeare to Health & Fitness (14 answers total)
If I were you, I would go ahead and pay $475 to a provider, make sure that they indicate to the Ins. co. that you paid it... wait for it to all clear, and then ask remaining to be rebilled to the insurance company... I suspect that if it's within the same policy year it will be paid (less, of course, any copay or coinsurance you might owe on that amount)...
posted by HuronBob at 2:14 PM on June 14, 2015

In my experience the reckoning of how much is left on your deductible has nothing to do with when you physically pay the provider. So if you have $475 left then $475 paid to the providers should satisfy the deductible. However all of this info should be on your Explanation of Benefits forms for each procedure.
posted by bleep at 2:16 PM on June 14, 2015

Did you hand over your insurance when you went to the appointments? If you did, then most times they'll send the bill to the insurance company before they bill you. You'll get an EOB which tells you what, if anything, the insurance company is paying for, and why - so for the first $475 the EOB will state the charges and say none of it is covered by insurance because you haven't met the deductible, and for everything afterwards that qualifies it will show what portion the insurance is paying and what's left to you as coinsurance. If you did hand over your insurance initially and they did bill the insurance before billing you, then the fact that you owe $841 might mean that the $475 deductible, plus the coinsurance not covered by your policy, equals $841. The answers should all be on the EOBs.

If you haven't yet received an EOB for all of the relevant charges, wait for that to come before doing anything. If you or your providers haven't submitted anything to the insurance company (though it sounds like they have if your tracker says "processed") then that is the first step.
posted by exutima at 2:25 PM on June 14, 2015

I have all of the EOBs. They state what I've paid to my deductible ($525), what the insurance paid ($0, because I haven't met it), and what I owe.

I was really hoping that what HuronBob suggested was a thing, that I can have them rebilled. I just did not know if that was an option. I think this makes more sense now, I was just very worried that because I wracked up so much without paying the deductible that I would have to pay everything I owed too, and then get the coinsurance on any following appointments.
posted by motioncityshakespeare at 2:35 PM on June 14, 2015

The provider may have billed you before they received payment from the insurance company. I would call them and ask to talk to someone in the billing office, explain that after another $475 you'll have met the deductible, and ask them to recheck your account.
posted by something something at 2:51 PM on June 14, 2015

Is there an "applied to deductible" column? I literally made a spreadsheet of this, since we have significant pharmacy claims that don't get an EOB but still count against the deductible. Me mail me and I can send you a sanitized version.
posted by chesty_a_arthur at 3:01 PM on June 14, 2015

I don't think you have to have paid yet for it to count towards your deductible.

My insurance policy allows me to view a summary of how much I've paid towards my deductible online. This year, when I got some health care (I am generally not a big health care consumer), the website started listing items before I'd even been billed by the providers for them, with the amount I was to pay (same amount as listed on my Explanations of Benefits) listed as counting towards the deductible.

Check if your provider has something like this accessible to you (if you haven't already) but even if not, I'm pretty sure that's how it works in terms of billing. Your insurance company doesn't even have a way of finding out if you've paid your share to your providers, as far as I know. Your provider bills your insurance, your insurance has a negotiated rate they pay per procedure (normally less than the sticker price), they pay none or some or all of that depending on your deductible and your policy and all that, and they tell the provider to bill you for any remainder. After that, I think they're out of the loop.
posted by mister pointy at 3:16 PM on June 14, 2015

You don't have to have paid the provider yet to have it count towards your deductible- fun fact, even if you end up not paying the provider, whatever your insurance company applied to the deductible still counts in their world.

If I were you, I'd call my insurance company and have a conversation about your plan details. In particular, get the current state of your deductible, and go over each date of service to make sure everything was processed in-network so that you're not paying the provider more than your insurance says you have to. Something here is not adding up- did you have lab services, emergency room services, or something else that wouldn't be applied to that $1k deductible? Some plans process some things separate from your main deductible. Or, did you accidentally see someone out-of-network?

I work in healthcare billing, feel free to MeMail me if you'd like me to look everything over for you.
posted by ThePinkSuperhero at 3:48 PM on June 14, 2015 [1 favorite]

Pinksuperhero and others are correct. I recently had some pretty expensive tests done that kinda had to be done like *right the heck now*. I paid the people that did the work (Testing Lab) half what it would cost me, and they are going to bill me in installments for the rest. The amount was basically equal to the amount the Ins. Company had as my remaining deductible.

Now, my deductible is satisfied as far as Ins. Company is concerned, but I still have to finish paying off Testing Lab.
posted by rudd135 at 5:59 PM on June 14, 2015 when I pay the provider after they bill the insurance, that does not go towards my deductible? I seriously had no idea that was the case.
posted by motioncityshakespeare at 5:37 AM on June 15, 2015

I understand it now. I can't tell if I'm better or worse off, but at least I'm on board. Thank you everyone!
posted by motioncityshakespeare at 5:52 AM on June 15, 2015

If all of these bills have gone through your insurance, but your insurance company still says that you haven't met your deductible, then there is something else going on.

You need to look at each EOB in the order of the date of service, and you need to find out how much of that bill went toward your deductible and how much did not, and WHY NOT.

The answer is almost NEVER "because you haven't paid the doctor yet". That's not how insurance companies work. They process the claim assuming that you will pay the doctor exactly what they say you should pay. And then the next bill should start FROM THAT POINT and keep going forward until the amount for the deductible is accounted for, even if you never have paid the actual doctor's office.

If your bills aren't knocking down your deductible bit by bit each time your go to the doctor, then you need to look on the EOB for some letters/numbers that indicate the reason why not. It could be because your doctor is out of network, or that your procedure is not covered by the insurance company, or many other reasons. But it's almost never "because you haven't paid the doctor yet".
posted by CathyG at 11:47 AM on June 15, 2015

When I quoted the original number of 800 some, I wasn't looking at the plan year I was looking at the calendar year. The math does add up unfortunately.
posted by motioncityshakespeare at 7:39 PM on June 15, 2015 when I pay the provider after they bill the insurance, that does not go towards my deductible? I seriously had no idea that was the case.

I think you said you understand, but just to be clear using an example for anyone in the future who reads this thread: you see a doctor. They send the insurance a bill for $400. The insurance says the allowable rate for this in-network visit is $200, and they apply the $200 to your $1000 annual deductible; your remaining deductible for the year is now $800. You owe the provider $200; whether or not you pay the provider (and please pay!), your remaining deductible with the insurance is $800.
posted by ThePinkSuperhero at 6:23 PM on June 16, 2015

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