US Health Insurance
Discussion
My son emigrated a few years ago and became a US Citizen. He was recently hospitalised for 2 days because of an abscess that needed attention.
He initially told me that he had health insurance, but now says that it won’t cover all the costs. I’m wondering what kind of bill he may need to settle personally, whether there will be an excess to cover or it’s a percentage contribution.
Is there anyone with experience of this that can advise please.
He initially told me that he had health insurance, but now says that it won’t cover all the costs. I’m wondering what kind of bill he may need to settle personally, whether there will be an excess to cover or it’s a percentage contribution.
Is there anyone with experience of this that can advise please.
It's going to depend on what type of health insurance he has.
On my company provided health insurance for example, there's a Gold, Silver & Bronze plan.
Gold pays out more but costs more monthly.
Typically there's an annual excess that you will be liable for. Gold has less $ value to pay out of pocket.
Usually, the insurance pays out 80% of the costs & you are liable for the 20% up to the limit of your annual excess.
After that, the insurance pays 100% of costs.
Depending on the company you work for, there are "better" & "worse" health insurance plans.
Bigger companies can get better group deals as they have more employees.
Costs also vary on whether the Doctor/Hospital in in or out of network.
In means they fully accept your insurance & it's cheaper.
If your self employed & take out your own health insurance, it depends entirely on what you signed up for.
Sorry I can't be more helpful.
On my company provided health insurance for example, there's a Gold, Silver & Bronze plan.
Gold pays out more but costs more monthly.
Typically there's an annual excess that you will be liable for. Gold has less $ value to pay out of pocket.
Usually, the insurance pays out 80% of the costs & you are liable for the 20% up to the limit of your annual excess.
After that, the insurance pays 100% of costs.
Depending on the company you work for, there are "better" & "worse" health insurance plans.
Bigger companies can get better group deals as they have more employees.
Costs also vary on whether the Doctor/Hospital in in or out of network.
In means they fully accept your insurance & it's cheaper.
If your self employed & take out your own health insurance, it depends entirely on what you signed up for.
Sorry I can't be more helpful.
I have Medicare as I'm retired, and this shows just how complex health insurance can be here in the US.
https://www.medicare.gov/what-medicare-covers/your...
I had hernia surgery a few years back and the hospital billed Medicare $42,000, and I was only in the hospital for about 5 hours.
Medicare kicked it back to the hospital and in the end I had to fork out about $750.
Many of the hospital staff work for agencies and not for the hospital, so they will bill you separately and those bills will just keep on coming for months afterwards.
So no easy answer to your question I'm afraid,
https://www.medicare.gov/what-medicare-covers/your...
I had hernia surgery a few years back and the hospital billed Medicare $42,000, and I was only in the hospital for about 5 hours.
Medicare kicked it back to the hospital and in the end I had to fork out about $750.
Many of the hospital staff work for agencies and not for the hospital, so they will bill you separately and those bills will just keep on coming for months afterwards.
So no easy answer to your question I'm afraid,
As others have stated, not really enough information to make an informed suggestion. So much depends on the diagnosis, how it is coded, what his level of cover is and whether the treating clinic is in or out of network, as far as his insurance company is concerned.
Also stated, depends on what his insurance deductible is - if he has a high deductible (lower cost) plan, he may be responsible for several thousand dollars worth of un-covered treatment.
Also his treatment may be subject to several different claimants - the facility, the anesthesiologist, the physician, the pharmacy and so on.
American healthcare provision is SO different from socialized healthcare that it is truly baffling to the unfamiliar.
Also stated, depends on what his insurance deductible is - if he has a high deductible (lower cost) plan, he may be responsible for several thousand dollars worth of un-covered treatment.
Also his treatment may be subject to several different claimants - the facility, the anesthesiologist, the physician, the pharmacy and so on.
American healthcare provision is SO different from socialized healthcare that it is truly baffling to the unfamiliar.
He told me that he pays $350 per month through a workplace scheme, for him & his wife who are both 29.
No idea where that sits in the likely level of cover.
He recently received a six figure inheritance which was earmarked for house purchase deposit, he feels that sum will have been seriously dented
No idea where that sits in the likely level of cover.
He recently received a six figure inheritance which was earmarked for house purchase deposit, he feels that sum will have been seriously dented
N111BJG said:
He told me that he pays $350 per month through a workplace scheme, for him & his wife who are both 29.
No idea where that sits in the likely level of cover.
He recently received a six figure inheritance which was earmarked for house purchase deposit, he feels that sum will have been seriously dented
As we've said, it depends.No idea where that sits in the likely level of cover.
He recently received a six figure inheritance which was earmarked for house purchase deposit, he feels that sum will have been seriously dented
What you pay bears no relation to what you get. It depends on the scheme.
Rather than you both worrying, read the terms of the insurance.
It might not be as bad as you think
Just tell him to relax and wait it out. He'll receive a bunch of EOBs. Don't pay anything until all that happens.
He'll need to hit his deductible first. There's a summary document for his insurance which will give him a clue as to deductible, co-pay, co-insurance, and max out of pocket (individual + dependent). At $350 a month, he's likely on a PPO.
This will also depend on his accumulations - usage of the plan so far this year.
He'll need to hit his deductible first. There's a summary document for his insurance which will give him a clue as to deductible, co-pay, co-insurance, and max out of pocket (individual + dependent). At $350 a month, he's likely on a PPO.
This will also depend on his accumulations - usage of the plan so far this year.
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