Medical insurance question

[datwater]

I have a different medical plan this year and have a $1000 deductible to meet in a plan year. I don't usually use much medical care, however I have a condition which requires monthly supplies. Currently, in order to get them from the insurance approved provider, it costs me $69 per month - and at that rate I won't meet my $1000 deductible so I'm basically paying $69 per month. However I can get the exact same equipment directly from a different provider for $29 a month - but the insurance co tells me they won't apply that toward my deductible.

Which way do I go?

Also, this shows a bit, at least to me, why medical insurance is so f'd up. Don't you think they'd want to use the $29 a month provider rather than force me to use the $69 a month provider? It's disgusting.

 

[Gooberlx2]

Go the cheaper route.

However, it's possible there's yet another provider, within your network, that can also offer the supplies for cheap. Or perhaps your original provider will price match.

What are the supplies?

 

[techs]

The health insurance companies are your friend.
Would you rather have some government employee determine if you're eligible for a certain service, or a health insurance company employee who makes a bonus if he turns you down?

 

[MixMasterTang]

Originally posted by: datwater
I have a different medical plan this year and have a $1000 deductible to meet in a plan year. I don't usually use much medical care, however I have a condition which requires monthly supplies. Currently, in order to get them from the insurance approved provider, it costs me $69 per month - and at that rate I won't meet my $1000 deductible so I'm basically paying $69 per month. However I can get the exact same equipment directly from a different provider for $29 a month - but the insurance co tells me they won't apply that toward my deductible.

Which way do I go?

Also, this shows a bit, at least to me, why medical insurance is so f'd up. Don't you think they'd want to use the $29 a month provider rather than force me to use the $69 a month provider? It's disgusting.

Is it possible to buy the equipment? You'd hit your deductible for the year and not have to worry about it for next year and the years after.

 

[BoomerD]

What's the catch? Why does the different provider not meet the deductible? There has to be a reason...I'd insist on a detailed (and written) explanation.

In the end though, if you have no other medical costs to meet your deductible, you're out of pocket over $800/yr, but with the cheaper provider, you're only out of pocket about $350/yr.

 

[rudeguy]

Originally posted by: techs
The health insurance companies are your friend.
Would you rather have some government employee determine if you're eligible for a certain service, or a health insurance company employee who makes a bonus if he turns you down?

I kind of like how my new insurance works. They give me a debit card with $750 to use towards anything medical. The actual insurance policy has a $1500 deductible. So I put $750 in my FSA. Basically I get the first $1500 of any kind of health care for $750. I don't usually spend that much, but I can spend $750 of it on contacts, OTC drugs etc.

 

[datwater]

It's funny because the healthcare provider said, oh, you have "x" for insurance - you need to call this seperate number that's just for people with that carrier. The whole thing just stinks to me.

MixMasterTang - it's not an equipmenet lease, it's consumables that need to be replaced every month.

Thanks for the advice, BoomerD - perhaps I'll push the issue of getting the supplies elsewhere or ask "x" insurance company to recommend a different supplier with reasonable prices.

 

[datwater]

As far as I can tell there is no "catch" - it's like if Mwave is selling a retail boxed Intel CPU for $200, and Newegg is selling the same batch, same model, retail boxed Intel CPU for $175 ... but you have a customer who demands you get the one from Mwave to put in their machine. It's almost like there's a kickback for "x" insurance company or they have some other back end deal with the health provider company.

 

[techs]

Originally posted by: NSFW

Originally posted by: techs
The health insurance companies are your friend.
Would you rather have some government employee determine if you're eligible for a certain service, or a health insurance company employee who makes a bonus if he turns you down?

I kind of like how my new insurance works. They give me a debit card with $750 to use towards anything medical. The actual insurance policy has a $1500 deductible. So I put $750 in my FSA. Basically I get the first $1500 of any kind of health care for $750. I don't usually spend that much, but I can spend $750 of it on contacts, OTC drugs etc.

Good thing you haven't got really sick.

 

[xSauronx]

Originally posted by: techs

Originally posted by: NSFW

Originally posted by: techs
The health insurance companies are your friend.
Would you rather have some government employee determine if you're eligible for a certain service, or a health insurance company employee who makes a bonus if he turns you down?

I kind of like how my new insurance works. They give me a debit card with $750 to use towards anything medical. The actual insurance policy has a $1500 deductible. So I put $750 in my FSA. Basically I get the first $1500 of any kind of health care for $750. I don't usually spend that much, but I can spend $750 of it on contacts, OTC drugs etc.

Good thing you haven't got really sick.

why? then he could drop the grand and get his current meds for free, saving him $800 a year, what a deal!

/i am not a math person

 

[Turin39789]

Originally posted by: xSauronx

Originally posted by: techs

Originally posted by: NSFW

Originally posted by: techs
The health insurance companies are your friend.
Would you rather have some government employee determine if you're eligible for a certain service, or a health insurance company employee who makes a bonus if he turns you down?

I kind of like how my new insurance works. They give me a debit card with $750 to use towards anything medical. The actual insurance policy has a $1500 deductible. So I put $750 in my FSA. Basically I get the first $1500 of any kind of health care for $750. I don't usually spend that much, but I can spend $750 of it on contacts, OTC drugs etc.

Good thing you haven't got really sick.

why? then he could drop the grand and get his current meds for free, saving him $800 a year, what a deal!

/i am not a math person

It works that way. My cheapo plan comes with a 2k ded and they give me 1k on an HSA that rolls over from year to year. Before I meet my ded, everything is out of pocket, Doctors, Hospitals, even pharmacy is subject to deductible.

I never go over my free $1k and have enough built up for free lasik, and in the worst case scenario, I get horribly sick, Pay $1k of real money and after that everything is paid at 100% with no coinsurance. Doctors, Hospitals, Drugs, etc.

 

[Turin39789]

Originally posted by: datwater
As far as I can tell there is no "catch" - it's like if Mwave is selling a retail boxed Intel CPU for $200, and Newegg is selling the same batch, same model, retail boxed Intel CPU for $175 ... but you have a customer who demands you get the one from Mwave to put in their machine. It's almost like there's a kickback for "x" insurance company or they have some other back end deal with the health provider company.

still sounds dubious, if the second supplier is an actual physician/facility/pharmacy then even if they are out of network you they should apply to ded.

Of course if you are ordering them from a shady place, or out of the country I could see where it wouldn't register. The only thing that makes sense is that your carrier doesn't recognize the other place as a supplier, maybe there is a reason they don't qualify?