Can someone please help and explain to me why if I have Health Insurance why do I still have to pay doctor bills? Why does my health insurance only pay part of the cost for a test? This really confuses me...Thanks for your input! Thanks Mel! Your answer helped me alot! So I guess I need to actually go to the doctor more in he begininng of the year in order to get health insurance to pay 100%. Makes sense.
Insurance - 8 Answers
Random Answers, Critics, Comments, Opinions :
1 :
It's called "co-insurance." Many plans are set up so that you are paying 20% and the health insurance company pays 80% up until a certain point, where you have reached your "max out of pocket" and then 100% is covered. The ratio may vary, but 80/20 is pretty common. Some plans do exist with no coinsurance, though often you will have a higher deductible or premium. They always get ya somewhere. If you have the option to seek different plans, weigh cost of a plan with coinsurance and without.
2 :
~~Health care companies are for profit corporations. They want to make money and to do so means paying the providers the least amount they can, and pass off as much as they can to the consumer (and still stay competitive), so they make their nice big profits.~~
3 :
Health insurance could pay the whole bill, but your premiums would be through the roof. Paying part of the bill is accepting part of the risk, which makes your overall premiums lower. Plus, plans with lower copays and deductibles are typically targeted towards unhealthy people, so the costs are even higher than they should be. My advice, only go to the doctor when you need to. Any percentage of 0 is still 0. And no.... going to the doctor earlier in the year does not mean anything will be covered at 100%. It just means you'll get your deductible out of the way earlier. Copays do not count towards the deductible.
4 :
You fundamentally misunderstand. Health insurance does not pay 100% of the costs - it does not mean "free health care." It means cost sharing and protection against catastrophically expensive bills.
5 :
The article from the source explain very good this confusion. Look at "Problems Related to Procedure Codes" and "Problems Related to The UCR". I could make a summary, but there it is better explained.
6 :
Health insurance has a fundamental problem. At the point of use, neither the doctor nor the patient has any incentive to limit treatment to only what is required. For example, given the choice of two tests both parties may prefer the more expensive one - the doctor earns more and the patient feels better treated. Maybe you even do two tests, even if the simplest would do. In one sense this is not a problem for the insurance company - they just split the cost across all the premiums. However, it does tend to make the insurance progressively more expensive and unaffordable. Adding a copay encourages the patient to ask questions about the treatment cost while still being protected and giving some incentive to limit treatment. This brings a cost benefit, along with the straight reduction from you paying part of the cost directly. A deductible also acts to reduce the cost as it excludes smaller claims so the average claims per policy goes down. A lot of claims are small, and have expenses that are high compared to the claim size so there is a further cost benefit. Finally, all things being equal, you would expect generally healthy people to be attracted to the lower premiums offered with a high copay or deductible. Giving one more expected claims cost saving.
7 :
because in america we don't have socialized medicine. it's every man for himself so if the best deal you can cut with an insurance company is that you pay a premium, which doesn't guarantee coverage, and then you have to pay a portion of covered treatments, and on top of that 100% of non covered treatments, that's just the way it is. now if you're willing to pay 50% or more in payroll taxes, go and move to europe and let us know how their healthcare works.
8 :
If insurance paid for everything then what incentive would you have to not use it for any little pain you might have. So, if you used it more often the costs would be even greater than they are. It's a catch-22 because you could also argue that people don't go when they have small things which could turn into big things without proper treatment. Regardless we work on a system that transfers money. 'Utilization' is also why a $2,000 deductible is MORE THAN $2000 cheaper than a $0 deductible. Lower deductibles notoriously have more claims and get used more. And, to respond to the one above answerer....there are plenty of non-profit health insurance companies and those companies work the same as the for-profit ones. So, the notion that non-profit is somehow better is just wrong. If it was correct then the non-profit companies would be the only ones left in the states they do business in.
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