So, I used out-of-network insurance coverage for a variety of reasons, but thought about the cost per a $500 deductible, and 75% coverage thereafter. As it turns out the doctors submits a charge to the insurance company for a different amount than what I paid (out-of-pocket), sometimes the same, sometimes not the same. Then the insurance company turns around and decides just how much they would be willing to pay for the service, if it were up to them. Well, that turns out to be about 50 cents on the dollar. So either the doctor is severely over charging (by 100%), or the insurance company is not being fair. I understand with in network coverage, there is a numbers game being played with the providers charge and the 'contract' coverage that was negotiated and agreed upon apriori. However, I assumed, that when paying out-of-network, the deductible would accumulate true out-of-pocket expense, and the co-insurance (75%) would also be with respsect to what I, the patient, paid out of pocket. How wrong and misinformed. So, the $500 deductible is really like a $1000 deductible, and the co-insurance thereafter is like 37% (patient pays 63%). Seems like something unethical, or worse, to me. I was not expecting to pay so much, not even close. This is not good for someone on a no-income income.
Anyhow, just wanted to vent a bit, and let anyone else who may not be aware be informed of this trickery. Any thoughts or other stories like this welcome.
Anyhow, just wanted to vent a bit, and let anyone else who may not be aware be informed of this trickery. Any thoughts or other stories like this welcome.
