Understanding Medical Benefits

[bookworm79]

I want to make sure I'm clear on this....this is what my medical plan covers:

In Network Annual Deductible          $ 500.00
Out of Network Annual Deductible      $ 1,500.00

In Network Annual Coinsurance       $ 6,500.00
Out of Network Annual Coinsurance  $ 9,500.00

So does that mean if I had a surgery, say out of network, I would have to pay $9,500 of it if it was a surgery over $95,00?

Thanks!

[nichold]

I have Aetna as well and I called asking the same question just last Friday and was basically told the same thing. Hope that helps.

[selmaS]

  Hi...what u stated is correct....and even with a NS that does not deal with ins. I did not pay much over my coinsurance.....and I had all types of testing included in it....

And as of this yr, they add in co-pays...yea...they never did b4...so this  is very helpful.....but each ins carrier is diff...so, one is not like the other.

Make sure u ask about everyone that u will come in contact with in the OR too!!....These r people u do not meet awake....and u will get bills to ur ins, so make sure they all participate with urs.Ur Dr should be checking all that....I only mention it bcuz mine got all messed up and the one group copied my #'s wrong and I started getting the bills....it took 2 yrs to get it fixed, and nothing out of my pocket, but it was frustrating.

Make DH in charge of checking on all these issues...

[bookworm79]

No, I need to think about it and i'm a worrier anyway.  I don't want to be blindsided by anything, especially financial, so I wanted to be as informed as I could.  And good luck to Rylane as well.  Keep us posted.

[Rahe28]

That sounds better than the 9500.00. Glad you got the info, hope it is corrrect too.

~ I always get like a kid on the night before the first day of school when I have something major coming up. Nervous, excited, and anxious. Sorry, hope I didnt mak eyou think about it :)

Well wishes to you both for a good day !

[Rylanesmom]

That sounds right:) mine has different levels for self and family too.

[bookworm79]

I called Aetna.  She said that if I was to have some type of surgery, my individual out of pocket expense for the year would not go over $2,500 in network or $3,500 out of network per individual and $6,500/$9,500 per entire family.  For my family, our out of pocket expense would not go over $6,500 in network or $9,500 out of network.  So I said, just to be clear, if I had a major surgery, I personally for myself would not pay anything over $2,500 in network or $3,500 out of network and she said correct.  Hope she gave me accurate info.

[Rylanesmom]

I think I am in the calm before the storm .... Trying to get my ducks in a row but yes if I think about it I am a little nervous yet very hopeful:) I am praying with expectations!  

[Rahe28]

oh, I see now. Feel somewhat like a whack-o now. LOL, its not the way it was put it ws my foggy brain. I read something totally different than what it actually says.

Are you anxious now Rylanesmom....I know your surgery is coming up fast.

[Rylanesmom]

I googled coinsurance and definition is amount you are responsible for after meeting deductible

[Rahe28]

See, I took it differently than Rylanesmom and u. They should be a little more clear.

[Rylanesmom]

I think so ... I would call the number on the back of your card to verify

[Rahe28]

Hmm....that can easily be misunderstood. I took it as though you have up to 9500.00 in out of network annually. So you would be responsible for anything over that. However, I would call your ins. company and ask them to explain the way it works so that you are clear, becuase that is not clearly stated in any way. I know it is so frustrating dealing with the ins company, but to make sure, I would give them a call. Good Luck to you