Health Insurance

BaBeeLaiLai

BaBeeLaiLai
Okie...i recently just got insurance for myself because i turned 19 and was kicked off of the health insurance with my parents. Anywayz so i got health insurance now...got excepted and recently just started paying...can i go to the hospital now? just wondering...and also how do you go about looking for a hospital and a doctor? I read and looked under the health insurance website with Regence BlueCross and Blueshield..but i don't know what im suppose to do...am i suppose to call some doctor that i find that i might want and ask to be their patient? or do i go a hospital and they assign meeh to a doctor or what? i don't know...i am soo confused with this. please someone help.
 

mizterkevin

sarNie Juvenile
If you could before you decide to go to a doctor, call and make an appointment. They'll have you look at your insurance card and tell them some of the information like which group you are insured with or your group number. When you come in, most of them require to see your DL and Insurance card to make copies and verify with the insurance company how your payment method should be. If you're with BCBS (Blue Cross Blue Shield) than most likely you're with PPO (unless you're with POS) and paying probably a co-pay of 20 ish dollars for an OV (Office Visit)

Just look for the doctor that's right for you. Probably a general practice doctor. Some doctors take walk-ins and when you do that, just have your insurance card and DL and they'll take care of you after that, but you might have to pay a first time patience fee.

Call in, "hello, Dr. so and so's office"

You: "Yes, I would like to make an appointment"

"are you an existing patient?"

"no, I am not"

"do you have your insurance card with you"

and ect ect.


questions class?
 

KhoOnxNouxWanxJai

Staff member
I have blue cross blue shield also and about the same age as u, but I didn't get kick off my dad's because I'm still living under his roof and still a student, but what I did was go to a family clinic and just register there it's much more convienient however thats spelled lol, in my case I didn't have to pay anything....and u don't really have to make any phone calls unless u are doing something big or some kind of small operation... like when my sister had to get a root canal... it was gonna cost like 2000 but the insurance covered that, but u have to call the insurance or actually the doctor's office will take care of that and they'll let u know if its approved or not... but blue cross blue shield is really good with their insurance and most places take bcbs... just find a clinic that u wanna go to and register as a regular patient there ... hahaha and heaven knows a regular check up is like 400 bucks >__O at a family clinic so health insurance rocks =]
 

mizterkevin

sarNie Juvenile
I have blue cross blue shield also and about the same age as u, but I didn't get kick off my dad's because I'm still living under his roof and still a student, but what I did was go to a family clinic and just register there it's much more convienient however thats spelled lol, in my case I didn't have to pay anything....and u don't really have to make any phone calls unless u are doing something big or some kind of small operation... like when my sister had to get a root canal... it was gonna cost like 2000 but the insurance covered that, but u have to call the insurance or actually the doctor's office will take care of that and they'll let u know if its approved or not... but blue cross blue shield is really good with their insurance and most places take bcbs... just find a clinic that u wanna go to and register as a regular patient there ... hahaha and heaven knows a regular check up is like 400 bucks >__O at a family clinic so health insurance rocks =]
It's better to call in because if you come in without an appointment, you have to sit there while they prepare a new folder for you and fill out crap. You will probably also have to pay the full amount because they have to process and verify your insurance while you're sitting there.

Most GOOD clinics will have a nice website where you can fill out your Patient Information at home and be prepared when you come in to the office. Be Prepared because it's the best way to handle insurance. (and they'll call to remind you of an appointment)

From my understanding...without insurance a check-up for a first time patient is $90.00 (depending on the doctor) if they charge you $400.00 they're probably ripping you off.

around $70.00 for an existing patient.

other expenses depend on whether you're having blood drawn, urinal samples, Office surgeries, MRI ect

But if you have a co-pay, you only pay that much of the co-pay (being that of a flat price. ie: 20 dollars, 30 dollars...)

Now if you have a deductible, you pay a percent of that amount until you meet your deductible. ie: you have a 90/10 deductible of $500.00, you pay 90% of your visit until it adds up to be $500.00 then you only pay %10.

As great as copays look, I really like deductibles, I believe they work the best.

Root canals shouldn't cost that much:

Root canal treatment for a front tooth (incisor). $360.00 - $700.00

Root canal treatment for a back tooth (molar). $600.00 - $910.00

Seems like everyone's ripping you off Tina.




So...Call the office to schedule an appointment, have your insurance card, drivers license, patient information (if available online), and a big smile because they treat you badly if you're aren't nice.
 

BaBeeLaiLai

BaBeeLaiLai
hahaha...they treat you bad if you don't have a nice smile...hahaha thats funny...Thanks! you guys rock...so informative...one more question...what is the deductible...and why do they have that..i really don't understand what that is all about or for..and how it works...and yes i have a deductible of $500 i believe...and i am with PPO thats what it says on my insurance card...So would you guys recommend a hospital like Providence...or just a small clinic? I hate hospitals so i don't know what and where is best. And oh do you guys know anything about school health clinics...are we allowed to go there...i remember i use to go to my old high school clinic but then when i didn't have insurance anymore they stopped seeing meeh..they said they would only see meeh for family planning...sooo now that i have insurance does that mean i can go bak there...or still only for family planning..i feel stupid calling in and asking so yeah...because i had an ear infection once and needed a precription drug...didn't know where to get one...so that was when i called in and got rejected.

Anywayz Tina...you lucky...I guess i had a chance to stay with my mom's insurance too..but then i think at that time i decided that i didn't want to go to school anymore...sooo there was a paper that i didn't feel out..and then when i finally decided to attend college it was too late already...thats why i had to get my own health insurance...but then i got assitant with this one program that helps meeh pay like 70% of it...I only have to pay 30%. Pretty swt.
 

mizterkevin

sarNie Juvenile
hahaha...they treat you bad if you don't have a nice smile...hahaha thats funny...Thanks! you guys rock...so informative...one more question...what is the deductible...and why do they have that..i really don't understand what that is all about or for..and how it works...and yes i have a deductible of $500 i believe...and i am with PPO thats what it says on my insurance card...So would you guys recommend a hospital like Providence...or just a small clinic? I hate hospitals so i don't know what and where is best. And oh do you guys know anything about school health clinics...are we allowed to go there...i remember i use to go to my old high school clinic but then when i didn't have insurance anymore they stopped seeing meeh..they said they would only see meeh for family planning...sooo now that i have insurance does that mean i can go bak there...or still only for family planning..i feel stupid calling in and asking so yeah...because i had an ear infection once and needed a precription drug...didn't know where to get one...so that was when i called in and got rejected.

Anywayz Tina...you lucky...I guess i had a chance to stay with my mom's insurance too..but then i think at that time i decided that i didn't want to go to school anymore...sooo there was a paper that i didn't feel out..and then when i finally decided to attend college it was too late already...thats why i had to get my own health insurance...but then i got assitant with this one program that helps meeh pay like 70% of it...I only have to pay 30%. Pretty swt.
I don't know about this only paying 30% of things, but that's pretty sweet.

Let's just say that you have a 70%/30% with a $500.00 deductable. You have to pay 70% of all medical costs until it all adds up to be $500.00 then after you've paid a total of $500.00, you only need to pay 30%.

EX:

First Doctor's visit for you ear infection is an OMT (regular check up) -

$90.00 original price

You pay 70% of that: $63.00




Second, a prescription for your ear infection -

$50.00 original price

You pay $35.00

and a pain killer, original price $45.00

You pay $31.50


Third, you break your head when you overload on prescription pills and get dizzy -

$500.00 original price

You pay $350.00


Fourth, you need butt cream because you developed an unusual rash while in the hospital beds -

$50.00 original price

You pay $35.00



TOTAL: $514.50



After paying a total of $500.00, your ear starts juicing and the pus smells like cheese.

Go back to the doctor for another check-up:

Original Price $90.00

You pay 30%: $27.00


(with respect to them probably taking 70% off all the prices)





You don't need to go to the hospital unless you have something serious, how serious is that infection? You probably just need a prescription for some Cipro. If it's an infection from a piercing, get it checked asap.

Just find a family doctor, cheaper, and they can see you for a longer period of time.

I'm not sure about if you can see the school nurse...? haha...

If you call the clinic on a weekday, they can tell you how much you need to pay for a regular check up once you get your insurance verified. Is there a number on the card that looks like....70/30 or 90/10 or 80-/20?


But overall...

Smile is priceless :]
 

BaBeeLaiLai

BaBeeLaiLai
It's okie with the ear infection....it's gone now...i found this free medical clinic that helps people that has no medical insurance and is low income...so yeah i went there and they prescribed meeh with some kind of ear medication...the thing i want to go to the hospital or clinic for is for a lady thing...lolz...soo yeah...but anywayz...the 70% and 30% thing is Family Assistant Program that helps pay for my monthly bill for insurance coverage...so thats what it is...i believe it's called the primium...hahaha...gosh i suck at this.

All the card says is DED:$500
In-NTWK 80%/OUT_NTWK60%

Then theres these pictures at the bottom that has a picture of a doctors thingy to listen to your heart...dont' know what it's called...it says:

In $20
OUT $40

ER: $100

H: Blank
Dental: WDG
Vision: It just says Vision
Rx: $10 GEN(generic medications), 50% FORM, 50% NON-FORM

^^^^^^^^^^^^^^^^^^^^^^^^

Do those sound okay? hahaha...or does my plan suck...i have no clue...! What do you guys have?
 

BaBeeLaiLai

BaBeeLaiLai
Thanks to all soo much for helping meeh out...all the information that were provided were very helpful...thanks! I now understand my coverage and plan better...Thanks Agian.
 

BaBeeLaiLai

BaBeeLaiLai
Damnnnnn...a $1000 dollars...man when i was searching i wanted one without a deductible...cuzz i didn't know what that was. hehehe
 

KhoOnxNouxWanxJai

Staff member
It's better to call in because if you come in without an appointment, you have to sit there while they prepare a new folder for you and fill out crap. You will probably also have to pay the full amount because they have to process and verify your insurance while you're sitting there.

Most GOOD clinics will have a nice website where you can fill out your Patient Information at home and be prepared when you come in to the office. Be Prepared because it's the best way to handle insurance. (and they'll call to remind you of an appointment)

From my understanding...without insurance a check-up for a first time patient is $90.00 (depending on the doctor) if they charge you $400.00 they're probably ripping you off.

around $70.00 for an existing patient.

other expenses depend on whether you're having blood drawn, urinal samples, Office surgeries, MRI ect

But if you have a co-pay, you only pay that much of the co-pay (being that of a flat price. ie: 20 dollars, 30 dollars...)

Now if you have a deductible, you pay a percent of that amount until you meet your deductible. ie: you have a 90/10 deductible of $500.00, you pay 90% of your visit until it adds up to be $500.00 then you only pay %10.

As great as copays look, I really like deductibles, I believe they work the best.

Root canals shouldn't cost that much:

Root canal treatment for a front tooth (incisor). $360.00 - $700.00

Root canal treatment for a back tooth (molar). $600.00 - $910.00

Seems like everyone's ripping you off Tina.
So...Call the office to schedule an appointment, have your insurance card, drivers license, patient information (if available online), and a big smile because they treat you badly if you're aren't nice.

but but I didn't pay 400? I paid 10 dollars for the visit ... so I guess they ripped off my insurance ... ah I had no other choice thats the place closest to my house... remember I do live in a forest on a hill... =x lol
 

wintr

sarNie Hatchling
It's better to call in because if you come in without an appointment, you have to sit there while they prepare a new folder for you and fill out crap. You will probably also have to pay the full amount because they have to process and verify your insurance while you're sitting there.

Most GOOD clinics will have a nice website where you can fill out your Patient Information at home and be prepared when you come in to the office. Be Prepared because it's the best way to handle insurance. (and they'll call to remind you of an appointment)

From my understanding...without insurance a check-up for a first time patient is $90.00 (depending on the doctor) if they charge you $400.00 they're probably ripping you off.

around $70.00 for an existing patient.

other expenses depend on whether you're having blood drawn, urinal samples, Office surgeries, MRI ect

But if you have a co-pay, you only pay that much of the co-pay (being that of a flat price. ie: 20 dollars, 30 dollars...)

Now if you have a deductible, you pay a percent of that amount until you meet your deductible. ie: you have a 90/10 deductible of $500.00, you pay 90% of your visit until it adds up to be $500.00 then you only pay %10.

As great as copays look, I really like deductibles, I believe they work the best.

Root canals shouldn't cost that much:

Root canal treatment for a front tooth (incisor). $360.00 - $700.00

Root canal treatment for a back tooth (molar). $600.00 - $910.00

Seems like everyone's ripping you off Tina.
So...Call the office to schedule an appointment, have your insurance card, drivers license, patient information (if available online), and a big smile because they treat you badly if you're aren't nice.
im getting a root canal done on me in two weeks...they told me that i only have to pay a co-pay of 168 dollar...my dental insurance is with safe guard...i was also hospitalize for a month for pneumonia after having my baby boy...medical pay for the delievery but i dont kno if they are gonna pay for the pneumonia treatment...now that medical cut me off my hubby bought me health insurance...i pay 50 buck each visit..and i spent over 2000 just on medical bills since they didnt take my medical.but i got a big discount on my MRI it was suppose to be 2000 somthing but they gave me a discount of only 450 bucks to me that is a good deal..so should i keep with my doctor or should i change...he was the one that admit me in and monitor my health...but to me he seem to be a lousy doctor...

My insurance plan is called Avalon 10 HMO

OV-10-copay
Diagnostic X-ray and Lab-10-copay
Prescriptions-Gen-15 Form-25 Non-Form-45
Inpatient Hosptial-100%
Outpatient surgery-100%

is this a good plan and what does the in and out mean when it comes to 100%
 

mizterkevin

sarNie Juvenile
Office Visit is a general visit to a doctor - $10
If you have a urinal, blood drawn, x-rays - $10
Generic prescriptions are $15
Formulary prescriptiongs are $25
Non-formulary are $45

Now this last part is really good. 100% of your In/Out are paid...most people have to pay the entire thing which could save you hundreds.

Inpatient Hospital is where you stay over night

Outpatient surgery is where you can have the procedure done and go home the same day.

Credits to yunholovesly
 

slee00

sarNie Adult
Guess I looked at this page too late....I am an insurance agent...Blue Cross and Blue shields is one of my companies...Let me know i you still need assistance. IM me to get a faster reply. Thanks
 
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