Health Insurance Related Questions

[dotnetrockz]

deeniki evaraina claer ga ardham ayyetu chepthara?

Co-Insurance: 100% IN Network, 70% OUT of NetworkOffice
Copay: $25/$50 per office visit (Primary/Specialist)
Deductibles: $2,500/$5,000 Single/Family IN Network, $5,000/$10,000 Single/Family OUT of NetworkOut of Pocket Max: $2,500/$5,000 Single/Family IN Network, $10,000/$20,000 Single/Family OUT of NetworkPharmacy: $10/35/60 (Generic/Branded/Special)
Emergency Copay: $200 copay per visitUrgent Care Copay: $75 copay per visit

i mean in network and out network ante enti?

[sboyr2r]

bayata neku network providers vuntayi. health partners network, valley network, salvation networks tokka tolu... ee network third parties... service providers/doctors can individually sign up for any of these networks.... signing up in the sense they agree that they are going to provide each service at a specific price with these networks.... how they work is not what you should be bothered about.... these netwroks in turn work with insurance companies and they come to an agreement that these networks will provide services at reduced prices.... Remember insurance company also needs to pay your bill... so they try to bargain with the networks to charge them (them and in turn you) less...

So each insurance company identifies a/a few particular networks as their own networks... so ee network site ki velli service providers/doctors evaro chusukuni valla taggarikiv elte neku cheap padutundi... all other netwroks/doctors not in its (insurance company) specified network are out of network providers

[sboyr2r]

anymore questions?

[cherlapalli_jailer]

[quote name='Nissan' timestamp='1368029561' post='1303723379']
deeniki evaraina claer ga ardham ayyetu chepthara?

Co-Insurance: 100% IN Network, 70% OUT of NetworkOffice
Copay: $25/$50 per office visit (Primary/Specialist)
Deductibles: $2,500/$5,000 Single/Family IN Network, $5,000/$10,000 Single/Family OUT of NetworkOut of Pocket Max: $2,500/$5,000 Single/Family IN Network, $10,000/$20,000 Single/Family OUT of NetworkPharmacy: $10/35/60 (Generic/Branded/Special)
Emergency Copay: $200 copay per visitUrgent Care Copay: $75 copay per visit

i mean in network and out network ante enti?
[/quote]
if porvider( or fecility) is not listed in the Insurance company then they are out of net work

if u goto Ins company web site you will find list of Providers that are in their net work in your locality.

if the provider u visited is not in their net work then that provider will inform you about this b4 the treatment

This happens mostly in travel ins and/or small ins

Out of network pharmacy???? this is doubtful ...coz all of them will be in net work...(so if this is some thing to do with out of network provider's prescription ??? not sure)

[bio]

nee insurance provider ki oka network of doctors, hospitals, emergency care etc untaayi (deenine in network antaaru), neeku edainaa prob voste in network ki velte cheap ga avutundi, you can also go to out of network doctors/hospitals/etc akkadikelte neeku bill ekkuvavutundi.

co-pay ante nuvvu oka visit ki velte minimum pay cheyyalsina amount adi
deductibles ante nuvvu nee pocket nundi pay chese maximum amount adi (patients responsibility anna maata) say if 10,000 dollar bill unte, nuvvu nee pocket nundi 2500 pay chestav migathadi insurance pay chestadi, 2400 bill padithe mottham nuvve pay cheskuntavu.

10/35/60 pharmacy ki nuvvu pay chesedi.

adee matter.

[dotnetrockz]

Thnx everyone for detailed explaination

[Guest]

In network ante nee insurance company network lo unde physicians and hospitals, site lo login aythe supistundi list, out of network lo velte vere charges untayi ani meaning

copay ante nuv kattedi per visit irrespective of what the doctor or hospital charges, its a flat amount
Deductibles ante, oka calendar year ki neeku hosptital charges oka 20k aynay anko(max limit varku entha ayna kooda) nuv andla $2500 kattale/$5000 for family(in ur case).

[karna11]

[mohanm]

[quote name='bio' timestamp='1368030948' post='1303723508']
nee insurance provider ki oka network of doctors, hospitals, emergency care etc untaayi (deenine in network antaaru), neeku edainaa prob voste in network ki velte cheap ga avutundi, you can also go to out of network doctors/hospitals/etc akkadikelte neeku bill ekkuvavutundi.

co-pay ante nuvvu oka visit ki velte minimum pay cheyyalsina amount adi
deductibles ante nuvvu nee pocket nundi pay chese maximum amount adi (patients responsibility anna maata)[color=#ff0000] say if 10,000 dollar bill unte, nuvvu nee pocket nundi 2500 pay chestav migathadi insurance pay chestadi, 2400 bill padithe mottham nuvve pay cheskuntavu.[/color]

10/35/60 pharmacy ki nuvvu pay chesedi.

adee matter.
[/quote]


Ikkada koncham clarity ivvava?

[cherlapalli_jailer]

[quote name='mohanm' timestamp='1368031522' post='1303723563']
Ikkada koncham clarity ivvava?
[/quote]
that si for those who r hospitalized like axccidents, or some disease(lie Bi pass etc
if one's bill is say 10K theny they have to pay 2.5K and Ins will pay 7.5k

suppose if the bill is 2K then the person has to pay in total Ins will not pay any thing

[sboyr2r]

[quote name='bio' timestamp='1368030948' post='1303723508']
nee insurance provider ki oka network of doctors, hospitals, emergency care etc untaayi (deenine in network antaaru), neeku edainaa prob voste in network ki velte cheap ga avutundi, you can also go to out of network doctors/hospitals/etc akkadikelte neeku bill ekkuvavutundi.

[b] co-pay ante nuvvu oka visit ki velte minimum pay cheyyalsina amount adi[/b] [color=#ff0000]lets rephrase it.. minimum kadu... doctors visit ki pay cheyyalsina amount.... consultation fee anuko... services (X-Ray, CT scan et cetera) vunte adi malli extra ne plan ni batti pay cheyyali.... those count towards deductibles....[/color]
[b]deductibles ante nuvvu nee pocket nundi pay chese maximum amount adi[/b] (patients responsibility anna maata) say if 10,000 dollar bill unte, nuvvu nee pocket nundi 2500 pay chestav migathadi insurance pay chestadi, 2400 bill padithe mottham nuvve pay cheskuntavu. [color=#ff0000]you are wrong. Deductible ante nuvvu 100% kattalsina amount.... max amount kadu... for example ne plan prakaram insurance company 80% kadutundi nuvvu 20% kattali ani vundi.. nee deductible 200$ anuko... nuvvu emanna service tesukunte bill 1000$ anukundam.... nuvvu first 200$ (deductible) complete ga kattali... remaining 800$ bill (1000$-200$) lo 20% kinda nuvvu kattukuntu povali... insurance company only 80% of 800$ kadutundi..... 80% of 1000$ kattadu... endukante nee deductible 200$ kabatti..... deductible per instance kadu... per year kinda... ante for example neku ivala xray teyinchukovalsi vachindi... xray bill only 150$ ee... appudu nuvvu mottam 150$ kattali.... 3 months taravata neku inko problem vachi bill 600$ vachindi... appudu 50$ (remaining deductible katti to make up 200$, remmeber 150$ xray ki kattesav already) migata 550$ ki 20% lekka nuvvu kattali... 80% of 550$ insurance company kattukuntadi....[/color]

10/35/60 pharmacy ki nuvvu pay chesedi.

adee matter.
[/quote]

[sboyr2r]

[quote name='cherlapalli_jailer' timestamp='1368031784' post='1303723588']
that si for those who r hospitalized like axccidents, or some disease(lie Bi pass etc
if one's bill is say 10K theny they have to pay 2.5K and Ins will pay 7.5k

suppose if the bill is 2K then the person has to pay in total Ins will not pay any thing
[/quote]No you are wrong again. deductible amount nuvvu 100% kattali... taravata migilina bill ni ne insurance coverage ni batti insurance company pay chestadi.....

[cherlapalli_jailer]

[quote name='Daakumangalsingh' timestamp='1368032898' post='1303723723']
No you are wrong again. deductible amount nuvvu 100% kattali... taravata migilina bill ni ne insurance coverage ni batti insurance company pay chestadi.....
[/quote]
ade kada cheppindi....akkada deducible 2.5K

[sboyr2r]

[quote name='cherlapalli_jailer' timestamp='1368033013' post='1303723736']
ade kada cheppindi....akkada deducible 2.5K
[/quote]enti nuvvu cheppindi... bill 10K avute deductible amount 2.5K kabatti 7.5K insurance company kadutundi annav.... adi wrong anna....
nee deductible 2.5K avute.... nuvvu 2.5K mottam katti... malli migata 7.5K lo nee insurance plan prakaram (80-20%) split avute, 20% of 7.5K kattali nuvve.... migatadi insurance company kattukuntadi.... usual ga single ki deductible antha huge vundadu... some 500$ vuntundi....

[bio]

[quote name='mohanm' timestamp='1368031522' post='1303723563']
Ikkada koncham clarity ivvava?
[/quote]

ok say nuvvu doc daggiraki vellavu, neeku bill $10,000 padindi anuko, then nee pocket nundi $2500 compulsory pay cheyyali, migatha $7500 bill lo insurance company responsibility 80% anuko ($6000) vaadu pay chestadu, so ippudu nuvvu pay cheyyalsina mottham bill $2500+$1500 = $4000.

if you bill does not exceed $2500, then mottham bill nuvve pay cheskuntavu, insurance vaadiki responsibility undadu.

clear ah??

PS : insurance responsibility entha % untadi anedi depends on your plan. nenu cheppindi example.