Full Rate or Discounted Insurance Rate?

[gadgetdog]

Hi,

My wife and I are currently on her employer's group health insurance. When the doctor bills her health insurance plan, the doctor has to accept the reduced fees that the insurance company pays.

Here is my question. After we go on private insurance, it will have a large deductible. We'll have insurance, but most if not all the payments will be paid by us, not the insurance company.

So, before we reach our deductible, will Doctors and other health providers charge us the full amount, or will they charge what the insurance would normally play since they are a provider within that insurance care group?

I imagine that this situation may apply for those who are on high deductible HSA plans as well.

If it matters, we are in Texas.

Thanks!
Charles

 

[REWahoo]

I'm also in Texas on private insurance (BCBS) with a high deductible. The short answer is you will pay the reduced (contract) amount. Just make sure all bills are run through the insurance company first, where the charges will reduced to the insurance company discounted contract rates before you pay.

 

[gadgetdog]

Thanks for the reply and the info. Did you use an insurance broker to buy the insurance or did you use a website like ehealthinsurance.com (or something like it?)

We are trying to get some basic questions answered about insurance in Texas. For example, from what I read, if you have had group health insurance for a continuous 18 months, then the insurance company that sells you a policy will give you "credit" for the 18 months and you will not face a pre-existing condition exclusion period. If they decide it is pre-exisiting, then they can refuse to pay for related expenses.

However, another part say that if you make a claim during the first 2 years, your individual heatlh insurer can look back 5 years from the time of your application to see if the claim is for a condition that they would consider pre-existing condition. Does the first part above (18 month credit) override the 2nd part?

Thank again!

Charles

 

[Johnphx]

I am not in Texas, but I do have a HDHP w/HSA.

Have all your charges billed to your insurance account. The insurance won't pay them, but they will reduce those charges to the lower amount and tell you exactly what you owe.

If you don't do that, then yes the doctors will try to charge you the higher fees.

 

[REWahoo]

gadgetdog, I'd suggest you spend some time reading the information Martha assembled for the forum regarding buying health insurance. I promise you it will be time well spent.

http://www.early-retirement.org/forums/f47/buying-private-health-insurance-30756.html

 

[gadgetdog]

Hi ReWhaoo, That's the first place I went and have read everything there. Martha did a good job putting all that together. I am down to just trying to figuring out between those two seemingly (to me) conflicting parts of the documents. I actually quoted the info above related to my question from one of the documents that Martha linked to that related to Texas.

Thanks!

 

[REWahoo]

Did you use an insurance broker to buy the insurance or did you use a website like ehealthinsurance.com (or something like it?)

After using ehealthinsurance.com to get some idea of what policies were available in the state for me and who the insurer's were, I contacted the insurance companies directly. Had I to do it all over again, I might have been better off finding a broker to do some legwork and pre-qualifying for me.

As to your other questions, I'm not going to try to respond and risk getting it wrong - no reason to take a chance on misinforming you. A good broker should be able to help you get all the answers.

 

[tomz]

Here is an interesting article about the complexities of health care billing. It was written by the editor of Philadelphia Magazine and relates to his experience with his 5-year old's appendectomy. As he discovered, it is very difficult to get a handle on charges, discounts, and deductibles.