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Special-K
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Member Since Jun 2010
Location: Tacoma, WA
Posts: 55
14
Default Jun 15, 2010 at 05:29 PM
 
It is likely that your husbands company had to switch coverages because 100% paid for is no longer realistic in this day/age.
I help large companies put together their whole benefit package, I've been an insurance agent for 11 years.

Who ever told you there are more copays because it is medically necessary is being missunderstood or they miss-stated. When ever there is a hospitilization it is subject to deductible/coinsurance. There are scarce plans that still pay 100% for hospital but they are almost all HMO's.
Of course plans vary per state, I can't speak on behalf of all states. But given the circumstances you have above if he has a colonoscopy for colon cancer which is quite serious $1,200 is actually little to pay if you look at the whole bill.

I am not saying you should not be frustrated with the customer service reps. These are usually entry level people they hire & they do not always give the right answer. We have a joke in the insurance industry, don't like the answer you got? Call back & see if you get a different one.

Today a rich plan is $250 deductible & 90% coinsurance (in-network) 90% the insurance company pays & 10% you pay. A typical plan is more like $500 Deductible 80% coinsurance. My plan (I'm an agent!) has a $1,000 deductible & 80% coinsurance.

I understand going from 100% to now having a lot of cost shares is frustrating. But our healthcare is out of control expensive right now & it sounds like your plan is pretty rich in comparison to what I see every day.

I hope I helped some. Good luck.
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