How does insurance companies decide on how much deductible you pay in a single bill

[bilkarr]

Does anyone know how Insurance companies come up with how much you have to pay in your deductiable in a single bill?

We've had this insurance for 8 years, if you go through all the statements from them there is no consistancy on how they apply the deductiable. It appears they just pull any dollar amount of there hat. I have never had to pay 300.00 in one lump sum

I just received the bill for my mammogram. It's supposed to be paid 100%. I get their statement.

out of a total bill for 473. Insurance pays 6.30 I pay 300.00 deductiable.

It's like come on. Of course I am disputing this.

But does anyone know how insurance companys decide how much of your deductible you pay in a single bill?

[snowpuppy]

I'm certainly no expert but will give it a go & a bump for you.

 

You usually have an annual deductable for hospitalization(procedures/lab & radiology) and one for dr visits. My ins kicks in Jan 1st of every yr so find out when your 'year' begins. Check with your state to find out if there is a max $ that you can pay for a mamogram. When I lived in OH, they had a state law the MAX charge for a mamogram was $87 to make it affordable for every woman to have one. I had one at that very famous hospital and was charged a whopping $500. Of course, everything over $87 was written off by the hospital to keep their not for profit status.

 

Also along female lines, I went in to see my PCP for my annual gyn exam. I told her I had an upper respiratory infection as well during the visit. I got billed for TWO co-pays for one visit. My ins said I was indeed liable for two co-pays in one visit as I had two separate visits?!

[breeze]

Probably different things have specific coverage amounts or co-payments. Like certain office visits you pay a co-payment only. Some procedures may be covered at 100%. Someone would have to read your contract and see a bill to break it down for you.

 

the 2 copays in one visit - probably thank the Dr's office for that. They wanted to get paid for two visits.

[snowpuppy]

Hi Breeze, you're correct, it was the Dr's office that was demanding two co-pays @ $20 bucks each for two separate visits. I paid my co-pay for the gyn visit when I checked in and was billed the 2nd co pay after asking for treatment for the upper respiratory infection. They were adamant about the lousy $20, called me to ask for it & threatened to send it to collections.

 

Guess she was short $20 for her Mercedes pmt that month.