General Discussion
In reply to the discussion: This message was self-deleted by its author [View all]dflprincess
(29,357 posts)And it's probably the deductible. I'm guessing the OP may have one of those lovely high deductible (aka "consumer driven"
plans that doesn't pay a dime until you hit the deductible. If it's a really lousy policy the actual out of pocket amount could exceed the $3k as the insured could still be on the hook for copays. When it comes to the high deductible plans copays may be applied to an additional out of pocket annual maximum or you might be on the hook for all of them with no annual cap.
A year ago I was doing contract work which paid well, but had lousy insurance coverage - one of the high deductible plans and it's deductible was just a bit under $6,000 (the legal limit for these plans is now just over $6k but the law only allows you to put less than $4K into the health savings accounts that always accompany these scams). I took a very large pay cut to accept a permanent job with great benefits. I figured one major medical event would make up for the difference in my take home pay.
Lucky I did that.
The policy I currently have has a $1,500 annual out of pocket max that, as long as I'm in network (and nearly every medical facility in the state is in network) is pretty much made up of copays. In January I broke my wrist and did such a number on it I needed a plate put in. The amount billed my insurer (including ER, surgery, follow up visits and therapy) was over $26,000. The negotiated amount was around $14,000 - of that I paid about $500 out of pocket - all for copays. Had I had the old insurance the deductible would have been $6k AND I would have had to pay the $500 in copays (probably more, I'm not sure what the copay rate was on that policy). Not ot mention all the hassles with the for-profit insurer I was with at the time (I had had to fight with them to pay for some screening tests that the law says must be covered). The non-profit I'm currently with paid claims faster than I have ever had the most minor claim paid by other companies.
Sadly, the ACA will allow these high out of pocket plans to continue and more people will be stuck with them as the cost of health "insurance" continues to rise. The bill may require that we have insurance - but it does nothing to guarantee access to care.