So my wife has an appointment tomorrow for a procedure that’s been scheduled for a few weeks, and today the doctor’s office called and asked her to “prepay” our bill, because (in her words) “Insurance won’t pay more because we’re so close to our deductible and about to hit coinsurance”.
As for our health insurance, we’re in an HSA w/ high deductible health plan, and if i look at my current status of it, we’re sitting at $5,590/$5,700 for our deductible (and after that we have about $2000 in coinsurance).
Now, i more-or-less understand how coinsurance, deductibles, and all this fit together, but the explanation of “why” we need to prepay this $700 doesn’t sound right to me. I told her NOT to prepay, and to politely tell them “no thanks, i’ll wait for the explanation of benefits before I pay anything”.
It’s worth noting that there currently IS NO claim on our insurance for this procedure yet, but i’m really questioning what the office means when they say that “insurance won’t pay more because we’re close to our deductible”.
I’m mostly just really confused about this situation and hoping someone can maybe help me understand what might be going on? As it stands, i’m thinking maybe the doctor’s office is confused? Because the way i see it, if its a $700 bill, $110 of it should go to our deductible, and then the rest goes to a 20% coinsurance (so about an extra $118 for me out of pocket or so)
Thanks in advance! (BTW i hate american insurance!)
Edit: – Update:
I talked with my insurance company, and while the rep said he can’t speak for how much the procedure would be estimated at, he recommended exactly what i was thinking and the handful of replies have said so far – Decline to prepay, and wait for an EOB and probably ask for an itemized bill, because that’s ideally how my plan should be working. He also said that if the claim doesn’t come through them first that it’s difficult for them to track deductible and co-insurance.
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So my wife has an appointment tomorrow for a procedure that’s been scheduled for a few weeks, and today the doctor’s office called and asked her to “prepay” our bill, because (in her words) “Insurance won’t pay more because we’re so close to our deductible and about to hit coinsurance”. As for our health insurance, we’re in an HSA w/ high deductible health plan, and if i look at my current status of it, we’re sitting at $5,590/$5,700 for our deductible (and after that we have about $2000 in coinsurance). Now, i more-or-less understand how coinsurance, deductibles, and all this fit together, but the explanation of “why” we need to prepay this $700 doesn’t sound right to me. I told her NOT to prepay, and to politely tell them “no thanks, i’ll wait for the explanation of benefits before I pay anything”. It’s worth noting that there currently IS NO claim on our insurance for this procedure yet, but i’m really questioning what the office means when they say that “insurance won’t pay more because we’re close to our deductible”. I’m mostly just really confused about this situation and hoping someone can maybe help me understand what might be going on? As it stands, i’m thinking maybe the doctor’s office is confused? Because the way i see it, if its a $700 bill, $110 of it should go to our deductible, and then the rest goes to a 20% coinsurance (so about an extra $118 for me out of pocket or so) Thanks in advance! (BTW i hate american insurance!) Edit: – Update: I talked with my insurance company, and while the rep said he can’t speak for how much the procedure would be estimated at, he recommended exactly what i was thinking and the handful of replies have said so far – Decline to prepay, and wait for an EOB and probably ask for an itemized bill, because that’s ideally how my plan should be working. He also said that if the claim doesn’t come through them first that it’s difficult for them to track deductible and co-insurance.
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