So I have arrived at a place in my life where I need medical care 2-4 visits a month, and the cost is $300 each visit. No big deal, I have insurance. Specifically I have a high deductible Insurance plan
No big deal I thought when I originally signed up for my insurance. I am healthy, I never go to the doctor, and hey, if something happens, my deductible is $1500 Thats not terrible and I have an emergency fund. My max out of pocket is $3425
So I submitted my first claim today, 2 visits, $600.
On a $600 claim, the percent they would cover is $277, or about 45%. I have no idea why only this amount is. covered, my benefit sheet online says “Services received on an outpatient basis in a provider’s office or at an Alternate Facility: 60% of eligible expenses after satisfying the deductible“
So, basically $139 from each visit goes towards my deductible. Its going to take me 9 more visits until I hit my deductible. 11 total visits, at $300 each until I hit my deductible. $3300 out of pocket, just to get to my deductible when they start actually reimbursing me.
That is going to leave $1925 on my max out of pocket cost. At $139 per visit, thats 14 more visits where I pay $162 per visit. 14 visits at $162 is $2268.
So now, my total cost is $5568, over 25 visits. Which at 2 visits a month means I will never exceed my max out of pocket in a year.
I am lucky to have insurance and I can afford my treatments, but TLDR, if you just look at the line “max out of pocket” like I did, you are in for some sticker shock.
O yeah, I have an HSA. The max per year is $3500. So it's nice that the first $3500 will be pre-tax, but at least 2k ( And likely more) is after tax.
Submitted May 10, 2019 at 01:16AM by CactusJ http://bit.ly/2JbSXTU
