[lenjan]

I have an absolutely lovely problem, I'm just confused!

My insurance at my new job started Dec. 1. Dec. 5 I had an appointment with my new hematologist. The bill came to $380, and I have a $250 deductible. I thought.

When I got the explanation of benefits, it said I was responsible for $232 of that, and that I had satisfied my 2007 deductible (for an appointment in December 2006!).

Now. I haven't paid a dime on that bill yet, since I just got it a week or so ago. I *did* pay upfront for my meds, for which I also have a $250 deductible (I thought). The deal as I understood it was, you pay the cash upfront, and 2-3 weeks later they send you a check for the total minus 20 percent that is your responsibility. My total expenditure on the meds was about $210.

Today I got 2 checks for the meds that come to 80 percent of their cost. I also got an EOB for my pdoc appointment on Jan. 3. The bill came to $305 (I'm new here and having to establish brand-new relationships with new doctors, so am getting hit with all the first-time "diagnostic evaluation" charges). According to the EOB, out of that $305 I'm responsible for about $34.

I'm sure I've totally lost everyone by now, but just in case I haven't -- can somebody please tell me how it's possible for me not to have paid a dime yet toward my dr. bills in 2007 and still be considered to have met the deductible? My HR rep at work is out the first part of next week and this is going to drive me batty till then. Mind you, as I said, I'm not complaining -- I'm happy to see the cash back, etc. I just have had bad experiences with insurance companies, and I want to make sure before I cash these puppies that they're not going to turn around and say "Oops! We screwed up! Pay us back!" LOL

Sometimes being a creative type sucks, because I just do not have the brain for this sort of thing, so please be patient with me. Mega-kudos to all who do this kind of stuff for a living!!

Candy

[Perna]

Simple :-) The insurance goes from policy date to policy date so whatever your company's "start" date is is the start for that coming year. So, for example, if your company signed up with the agency that handles its insurance in July of last year, your deductible would be for July 2006 to July 2007. So, when July comes around again and you get a new card and they re-evaluate experience and raise how much it costs, etc. then you'll be on the "next" year, July 2007 to July 2008 which will be called the 2008 year. Or, it just might be from your hire date (December) to the next December, etc., ask your company HR person what the "year" months are.

That's how my company works (the July thing) and we had that exact same confusing questions, don't feel bad.

I don't know that meds have a separate deductible; meds can be confusing as heck :-) I'd ask your HR person where you work, she "should" be able to explain it all but it's extremely "local" to your company and the agency you get your health benefits from, etc. There's often an agency/"middleman" in there, not just whatever your health insurance is provided by (e.g., Blue Cross, Prudential, Aetna, etc.).

[lenjan]

Aha! So in other words, I shouldn't run out and spend these on fun stuff. Our "plan year" starts Feb. 1. So when it's time to refill my meds in Feb., I'm going to have to fork out for them again, yes? Then the rest of the year will be OK.

Darn. I already had these spent! LOL

Thanks for making it comprehensible to dumb ol' me!

[TYMBERWOLV]

Candy,

Here is another explanation. Most Insurance Companies run on Calendar Days . Therefore if you had seen the Doctor near the end of 2006 last couple of weeks then the billing is not issued until 2007. Therefore the insurance companies sees the billing dates as 07 vs 06

So in advice contact your HR make sure that is the case or Perna's analysis could be correct

BTW I am in the insurance business

Tymber

[sabby]

There is another situation that could be happening. If you have only met your deductible in the last month of the year (regardless of when your insurance started) then they will "carry over" that deductible into the next year.

I'm not in the insurance or HR business, but this same situation has happened to me in the past.

[(JD)]

I agree, real insurance companies allow any deductible met during the last 6 weeks of the year, to carry over for the following year

[lenjan]

awesome . That must be what happened. My hematologist appt. was Dec. 5 and more than covered the deductible.

Yay! Thanks for the info!

[Rhapsody]

I personally would call your Insurance Company and see what their exact policy is...... for while some company's do run their year from the date you start - my insurance company runs their calendar year from Jan 1st to Dec 31st - - - no if or buts about it.


LoVe,
Rhapsody -

[lenjan]

Well, so much for THAT.

Today is Jan. 31. Tomorrow, our insurance plan year starts over. I am out of Risperdal entirely and went to pick up a refill over lunch. For which I had to pay the entire stinking amount.

Silly me, I thought since I'd satisfied the deductible LAST time, that this time I wouldn't have to fork out the entire $188.27, just the 20% copay. Which would have come to like $37. Which I could have afforded. I was so shocked that I had to pay the whole thing that it didn't occur to me till later that I should have asked them for a week's worth or something and called the pdoc.

Luckily, I was able to cancel an automatic payment before it went through, because otherwise I would have had $11 for the next 2 weeks, and zero, and I do mean not even a crumb, food in the house. Unfortunately, it was my gas and electric payment, but they can't shut you off here until April sometime (aka "the cold-weather rule").

Anybody know any eligible bachelors who wouldn't mind living in northwest Wisconsin (where it's currently a balmy 10 degrees) and who have both CPA and insurance agent certification? I was overdrawn by 56 cents this morning and am paying $31 for that, so I need somebody to just take over my money and figure out my copays!

GROWL.

CB (a very frustrated and growly bear right now!)

[biiv]

finances suck. how is it the more times you add the same sums together the more different answers you get? or is that just me?
(((((((((candybear))))))))))
if you growl like that at the bank maybe you can scare them into not charging for the overdraft?
seriously though. i hope things work out ok for you with the insurance.
good luck
biiv