I can’t for the love of God reach my insurance company by phone or email. Long hold times, auto hang-ups, and no replies. It’s a marketplace coverage plan and this will be year #2 with it.
My issues;
My portal on insurance plan reads :
Deductible
- $50 Individual total
- $150 Family Total
Out-of-pocket maximum
- $350 Individual total
- $700 Family Total
- In Network: 50% Coinsurance after deductible
- Out of Network: 50% Coinsurance after deductible
with $1,000 limit
The general handbook with the notice, “ The information on this coverage summary should be used only as a guideline for your dental benefits plan. For detailed information on your group’s plan, riders, terms, and conditions, or limitations and exclusions, refer to your plan’s Subscriber Certificate.”
Calender Year Deductible $100 individual/ $300 family
Insurance pays 40% under 19 / 50% 19 and older
My In Network dental office gave me a full treatment plan with the terms:
$100 deductible
60% Coinsurance after deductible
$1,000 limit
( I’ve paid $96.26 towards the bill/deductible already.)
The clinic estimate states I will pay $1,217.44 out of pocket.
and my insurance estimate reads $931.20 out of pocket.
$1,986.46 is the total work amount.
How does my out-of-pocket come into play with the work?
On my last visit, I asked the clinic if they needed to run my estimate through insurance again and they said no. Should I demand they rerun it? or just let them know my deductible and coinsurance are different than they are calculating. I don’t understand how they have it wrong.
I’m having work done tomorrow and they are expecting the 60% coinsurance to be paid. This is work I can’t wait on or I would wait just so I can speak to insurance first. This has been stressing me.
Thanks!
submitted by /u/IrisK_H
[link] [comments]
I can’t for the love of God reach my insurance company by phone or email. Long hold times, auto hang-ups, and no replies. It’s a marketplace coverage plan and this will be year #2 with it. My issues; My portal on insurance plan reads : Deductible
$50 Individual total $150 Family Total
Out-of-pocket maximum
$350 Individual total $700 Family Total
In Network: 50% Coinsurance after deductible Out of Network: 50% Coinsurance after deductible
with $1,000 limit The general handbook with the notice, ” The information on this coverage summary should be used only as a guideline for your dental benefits plan. For detailed information on your group’s plan, riders, terms, and conditions, or limitations and exclusions, refer to your plan’s Subscriber Certificate.” Calender Year Deductible $100 individual/ $300 family Insurance pays 40% under 19 / 50% 19 and older My In Network dental office gave me a full treatment plan with the terms: $100 deductible 60% Coinsurance after deductible $1,000 limit ( I’ve paid $96.26 towards the bill/deductible already.) The clinic estimate states I will pay $1,217.44 out of pocket. and my insurance estimate reads $931.20 out of pocket. $1,986.46 is the total work amount. How does my out-of-pocket come into play with the work? On my last visit, I asked the clinic if they needed to run my estimate through insurance again and they said no. Should I demand they rerun it? or just let them know my deductible and coinsurance are different than they are calculating. I don’t understand how they have it wrong. I’m having work done tomorrow and they are expecting the 60% coinsurance to be paid. This is work I can’t wait on or I would wait just so I can speak to insurance first. This has been stressing me. Thanks!
submitted by /u/IrisK_H [link] [comments]Read Morer/HealthInsurance