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Discounts and Deductable
Old 08-18-2007, 11:48 AM   #1
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Discounts and Deductable

Is it just my insurance provider, or do all of them do the following.

While I am in the deductable phase, ie before it is used up, the insurance will not apply any discounts, so I end up paying the full bill. Once the deductable is met, than the discounts come rolling in and as we know, they are very significant.

Is this normal or are there tricks to get the company to apply the discounts whether it is my nickel or theirs.

Appreciate any insights

Thanks
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Old 08-18-2007, 01:24 PM   #2
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Weird. I have never seen that. All the explanation of benefits I see show the cost, the amount allowed under agreement with the insurer (the discounted amount) and the amount of the deductible applied. We get the benefit of the discounts even before the deductible is used up. Are you sure you are reading your explanation of benefits correctly? They can be very hard to read sometimes.
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Old 08-18-2007, 01:28 PM   #3
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Have to agree with Martha, mine applies a negotiated discounted rate, then I pony up until I meet the deductible.

Charlotte
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Old 08-18-2007, 01:50 PM   #4
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Originally Posted by oliverdickens View Post
Is it just my insurance provider, or do all of them do the following.

While I am in the deductable phase, ie before it is used up, the insurance will not apply any discounts, so I end up paying the full bill. Once the deductable is met, than the discounts come rolling in and as we know, they are very significant.

Is this normal or are there tricks to get the company to apply the discounts whether it is my nickel or theirs.

Appreciate any insights

Thanks
Oliver - I am an insurance broker. I've never heard of a carrier that does not allow you to get their negotiated discounts until after the deductible is met. Normally, you turn in your claim (card) prior to getting billed. The insurance carrier discounts the claim to the "allowed amount", and then that is what you pay towards your deductible. Now - if you are going outside of the network, then that is a whole different story. Then, you pay the actual cost, and that applies to your separate, "out of network" deductible. What carrier do you have?
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Old 08-18-2007, 03:16 PM   #5
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Discounts apply while I am meeting the deductible.
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Old 08-18-2007, 03:26 PM   #6
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Are you refering to health insurance? The initial post is not clear on that point. Also not clear to me is what specific discounts you refer to. Most health plans negotiate a discounted price for most procedures and services that applies to anyone that is covered under the plan. Does your policy or plan document (SPD) spell it out any better?
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Old 08-18-2007, 04:01 PM   #7
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In network I get the negotiated discount till the deductible ($2400 in my case) is met. So I might pay $50 total at the discounted price for a dr's visit that "retails" at $110.

Dental insurance is another case though. All bets are off when it comes to that. We usually get no discount (we're out of network at our dentist) and end up paying much more than what the ins co is willing to pay.
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Old 08-18-2007, 06:23 PM   #8
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Yes I was talking about health insurance. How my example came about was during a normal physcial and blood tests, which are suppose to be covered 100%.

What happened is the insurance company incorrectly coded against my deductable, took no discount off, and I was sent the bill for the entire amount.

When I got it clarified, they reversed it, and low and behold, applied discount and paid about a third of the original amount.

My question came about as even if they did make the error as stated originally, I should have only be billed after the discount, but it appears they tried to put one past me.

At any rate thanks for the clarifications, as they will certainly helped out. We all know that one has to keep an eye out on the insurance companies as they will do anything to put one over on the customer if they can.

Appreciate the feedback
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Old 08-18-2007, 06:41 PM   #9
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What happened is the insurance company incorrectly coded against my deductable, took no discount off, and I was sent the bill for the entire amount.
If the insurance company corrected the claim, you should not have to pay the balance. If the provider (doctor) is in the network, they are not allowed to "balance bill" you (bill over the discounted amount).

Usually, when I see a claim like this, the problem is that the DOCTOR'S OFFICE codes the claim incorrectly as a "routine office visit" instead of "routine adult preventive care". Since office visits on high deductible plans usually go to the deductible, my guess is that the doctor's office was at fault in coding the claim improperly....when I work on claim issues for preventive care, it's almost 99.9% of the time a mistake made by the doctor's office in the way the claim was submitted. Resubmitting the claim with the correct code is usually all it takes to fix the problem.
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Old 08-18-2007, 07:37 PM   #10
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The company is First Health. I am assuming they just made a mistake, but will watch very closely. Just very strange on how they did it before I caught the error.

Thanks
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Old 08-18-2007, 08:02 PM   #11
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The company is First Health. I am assuming they just made a mistake, but will watch very closely. Just very strange on how they did it before I caught the error.

Thanks

Most likely what happened is that the Dr's office fixed the error before you even noticed it. Unfortunately, they sent you the first bill before the error was fixed. I would disregrad the first bill and then make sure with the doctor's office that no balance is due. (Again, you should not owe a balance above what the insurance carrier pays, if your doctor was in the network).
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Old 08-19-2007, 05:12 PM   #12
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Quote:
I am assuming they just made a mistake, but will watch very closely. Just very strange
Not so strange.

What is strange is that you took the initiative and investigated what did not make sense to you. Most members of group health plans will not take the time to ask simple questions about plan benefits since they consider it the employers plan and that they really have no say-so in how it is administered.

You have set an example for other members of the plan and should be proud of your efforts. If explanations do not make sense to you, they should always be questioned until a feasible response is given to your satisfaction.

Hope you use this experience to question future strange sightings in the future....
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