Health Insurance Explained

[sboyr2r]

Ee Insurance enti ee gola enti ani chala mandiki ayomayam… valla kosame ee post… idi chaduvute meku health insurance gurinchi vati terms gurinchi most ardham avutundi… mana bashalo examples tho rasanu…. Meeru insurance teesukune tappudu ivi chusukunte chalu…..

Insurance company asalu business enti… manishi bhayastudu… manaki emanna avute treatment ki dabbulu vundavu ane bhayam valla financial support kosam medical insurance teesukuntam…. Every month manam katte premiums insurance company teesukelli ekkado invest chesukuni business chesukuntadi… ala smart investing chestu vachina interest dabbula tho manaki mana treatment lo help chestundi…. Manam manchiga vundadame daniki kavali.. manaki ee jabbulu raka pothe daniki insurance kadutune vuntam and adi manaki eppudu dabbulu pettalsi radu… so more and more invest chestu vache interest ni malli invest chestu money grow chesukovadaniki chustadi…. andukane exercise cheyandi, free fruits antu mana health gurinchi pattinchukuntundi…. We should see this as a win-win situation….
[b]Insurance company:[/b] nuvvu insurance kosam paisal kattina vadu. Ex: Blue Cross Blue Shield, United Health, Aetna, IHC group, Humana, et cetera
[b]Network providers: [/b]Network providers ante third party companies…. Nuvvu kadu, insurance company kadu, doctors/hospitals kadu…. Vallu separate…. Vallu oka business model enchukuni same quality treatment cheap ki ela ivvala chustaru…. For example, knee replacement vunte aa replacement material India nunchi teppinche badalu same quality vi brazil lo vastayi…. Transportation cheap avutundi manaki ani anukuntaru… so rates lu taggi patient meeda bharam taggutundi…. Alane vellu doctors/hospitals ni contact chesi meeku kavalsina equipment/drugs memu ee price ki provide chestam… memu ee help chestunnanduku meeru knee replacement ki usual ga 1000$ charge chestaru kada… 800$ ee charge cheyyandi… ma network lo join avvandi ani adugutaru… it is a 2 way business dealing with doctors and network providers… ee dealings antha meku anavasaram… just explain cheddam ani chesanu…. Ilanti companies velli insurance companies ni contact chestayi….. idigondi knee replacement meku normal ga 1000$ avutundi kani memu meeku 900$ ayyela chestam…. Maa network ni teesukondi antaru… so ila insurance company chala manditho bargain chesi best deal iche network ni [b]In-network[/b] laga select chesukuntadi… all other networks become [b]out of network[/b] for the insurance company…. Out of network vallu discounts ivvaru kabatti meku charges ekkuva vuntayi… so insurance company kuda business chestundi kabatti mottam pay cheyadaniki ishtapadadu… so meeku ekkuva charge padutundi out of network velte….. insurance company oka network ni in-network ani just money offer medane conclude kadu… valla quality of service kuda chusi select chestadi… endukante meeku ippudu fever vachi velte manchi service ivvakapothe malli back veltaru… so more times you visit a doctor more bills and more is insurance company responsible… evvarikaina money ne kada kavalsindi….
[b]Service Providers: [/b]ninnu chuse doctor/hospital ni service providers antaru…
[b]Co-pay:[/b] Idi mana desam lo consultation fee laga anukondi…. Ante Doctor taggariki velte tanu charge chese consultation fee anthe kadu… they charge you more…. Kani Insurance pay chesukuntadi… nuvvu just aa co-pay pay chesukunte chalu…. General physician, specialist, surgeon ila nuvvu vellina doctor category ni batti and ne insurance plan ni batti co-pay different amounts vuntundi… for example, physician taggariki velte co-pay 10$ vuntundi.. ade specialist taggariki velte same health problem ayina co-pay 20$ vuntundi… ade surgeon avute $30 vuntundi….
[b]Deductible: [/b]Deductible anedi minimum amount you need to pay from your pocket before insurance company starts contributing towards your bill. For example, neku debba takina tummina aye $1, $20 kuda tane kattali ante kattadu…. Oka vela nee insurance plan prakaram ne deductible $300 per calendar year anukondi…. So first meku debba takindi.. bill $100 ayyindi… adi mottam mere pay cheyyali…. Next inko daniki $200 ayyindi adi kuda mere pay cheyyali….. So now $100+$200 =$300 (which is your deductible amount) ayyindi… ippati nunchi neeku ee bill vachina insurance will start contributing towards your bill…. So ippudu neku edo ayyi bill $1000 vachindi… so neeku two times already edo ayyindi 300$ deductible kattesav kabatti ee $1000 bill lo insurance company tana share kadutundi… tana share entha anedi nee insurance plan meda depend ayyi vuntundi… for example, nee plan $300 deductible and then 80-20 split anukundam…. So $1000 lo tanu 80% (800$) kadutundi nuvvu migata 20% (200$) kattali…. 80-20 plan enduku 90-10 plan ki veltanu appudu nenu 100$ ee kattochu anukuntaru… plan kavali meku worth anukunte teesukondi… alantappudu meeru katte monthly premiums ekkuva vuntayi…. ee 80-20 or 90-10 splits ne co-insurance antaru... 80% or 90% ni insurance company co-insurance responsibility, 20% or 10% ni patient co-insurance responsibility antaru....
Naku asalu nuvvu cheppinattu 3 time debbalu takaledu okka sari takindi daniki bill 1000$ ayyindi.. appudu ela ani anukuntunte…. Aa case lo mee deductible 300$ kabatti… 300$ meeru responsible… ippudu 1000$ lo 300$ me khata kabatti… migata 700$ lo 20%, which is patient co-insurance responsibility, (140$) malli mere responsible…. So ee case lo meeru 300+140=440$ kattali… insurance company 560$ kadutundi…. Next meeku emanna problem avute malli bill vaste dantlo inka deductible meru kattalsina avasaram ledu…. Ee bill lo only 20% meeru kattali….
Deductible ante per instance deductible ani mention cheyochu or per calendar year deductible ani mention cheyochu… jagrattaga chusukondi… mostly per calendar year deductible ee vuntayi…. Deeni ardham entante.. meeru 300$ every calendar year kattali… last year kattanu kada ee year enti, monnane one month back ee deductible kattanu kada ante kudaradu…. Calendar year marite deductible pakka kattali…
Meeru telusukovalsina inkonni vishayalu….
[b]Maximum out of pocket patient responsibility:[/b]
ee term mee insurance plan lo vuntundi chudandi…. What does it mean?
For example, mee insurance plan prakaram meeku [i]Maximum out of pocket patient responsibility[/i] 2000$ anukundam…. Ante entante…. Meku per calendar year lo chala issues vachayi…. Meeku bills chala ekkuva ayyayi… so ee bills anni kalipi 10000$ anukundam…. So for example, me deductible $300 and split 80-20 anukundam… so aa 10000$ lo meeru $300 (deductible) katti…. Migata amount ni 20% kinda kattukuntu veltaru…. Ee 20% +300$ (deductible) okka sari 2000$ ([i]Maximum out of pocket patient responsibility) [/i]touch avvagane migilina bill antha insurance company ne pay chestundi @100%...... so any calendar year lo meeku emi ayina meeru jebulonchi pettalsina dabbulu max 2000$ ([i]Maximum out of pocket patient responsibility[/i])….. idi kuda mostly every calendar year reset ayipoddi…. so most of them emanna issues vunte year mare lopale anni cheyinchukovali anukuntaru so that they can avoid deductibles and co-insurance charges… andukane hospitals Christmas time lo ekkuva rush ga vuntayi….
[b]Incident maximum, yearly maximum, lifetime maximum:[/b]
meeru teesukune insurance plans ki oka limit vundochu…. Ee limit ni incident maximum or yearly maximum or lifetime maximum ani mention cheyochu… English vachu kabatti ardham avutundi anukuntunna… so oka case teesukundam… for example, incident limit 50K$ anukundam…. And [i]Maximum out of pocket patient responsibility [/i]2000$, deductible $300 and split 80-20 anukundam…. so oka person ki kidney fail ayyindi… ee case one incident kinda vastundi….. ee kidney operation charges anni kalipi 60k$ bill anukundam…. so meeru deductible (300)+20% remaining bill until mee 2000$ ([i]Maximum out of pocket patient responsibility[/i]) ayyentha varaku kadataru… taravata insurance company 100% kinda remaining bill kadutundi… kani mee incident maximum 50k$ ee kabatti…. Additional 10k$ insurance company cover cheyanu antundi… so adi me responsibility malli…. Meeru iche tokkalo 100$ monthly premium ki daniki minchi memu pettala ani insurance company antundi… vallu business chestunnaru vallaki loss ravoddu kabatti ee rule pedutundi…. But maximum professional Full Time employee insurances ki ee limit unlimited vuntundi…. so no upper limit…. ilanti vallaki bill 2M$ ayina 100M$ ayina maximum vellu pocket nunchi 2k$ per year kadataru..... Ee maximum limit anedi mee insurance plan meeda dependant… per instance vundochu, per year maximum vundochu or lifetime maximum kuda vundochu…..

ivi health services ke cheptunna... same terms malli pharmacy ki kuda vuntayi.... ante meeru teesukunna treatment ki mandulu kavali kada.. aa mandulu konetappyudu kuda same terms vuntayi... adi pharmacy ani mee insurance plan brochure lone seperate ga raasi vuntadi chusukondi...

[sboyr2r]

ee terms ardham ayyaka... meeru teesukune insurance plan brochure okka sari chadavandi... mottam ardham ayipoddi... next time nunchi ee plan teesukunna ememi chudalo ventane meeke ardham avutundi.... evvarini adagaru ee plan tesukovali ani....
emanna questions vunna... or clarity leka poyina adagochu.... edit chesi better ga explain chesta.... future lo andariki panikostadi ani asistu... mee Daakusingh....

[anandam2012]

[dollar vora]

[madhub8]

Thanks for the info bhayya....
manchi insurance plan unte suggest chesthava koncham
neeku thelisina dental insurance kuda unte cheppu.........

[madhub8]

much helpful info.............

[karna11]

[dkchinnari]

gp

[sboyr2r]

[quote name='Reddy_001' timestamp='1368043366' post='1303724770']
Thanks for the info bhayya....
manchi insurance plan unte suggest chesthava koncham
neeku thelisina dental insurance kuda unte cheppu.........
[/quote]no one can. Why?
Each area lo service providers charge differently.... so business deal between service provider and network provider, and network provider and insurance company different vuntundi... so you never know which one is a good deal.... paina terms ardham ayyayi kada... nee requirements ento neku clarity vachaka ne requirements ki ee insurance better oo nee local area lo nuvve enquire chesukovali... google helps... me area lo most searched items ni batti results istundi kabatti neku telustundi.... colleagues/locals tho matladu manchi advises istaru.... Sory i couldn't be of much more help. Thanks.

[babu_andrew]

[Piscop]

[babu_andrew]

[quote name='Reddy_001' timestamp='1368043366' post='1303724770']
Thanks for the info bhayya....
manchi insurance plan unte suggest chesthava koncham
neeku thelisina dental insurance kuda unte cheppu.........
[/quote]

[url="http://www.ehealthinsurance.com/"]http://www.ehealthinsurance.com/[/url]

[Terminator II]

gp daku.. naku idantha already telusu anuko.. but vere vallaki use avuthundi..

[pavan_613]

Good post buddy !!!

[Tigersathi]

gp.. but whats the difference between co-pay and co-insurance then.. rendu same??