Why is my portion of medical bill not going towards the deductible?

1

Wondering if someone here has the explanatory deets on this before I go call up my insurance company and begin that whole series of shenanigans.

I have a $500 in-network deductible. I have had over $10k in medical bills so far this year (!), for which my out of pocket cost has been $900.

Of that $900 out of pocket cost, only $80 of it has gone towards my deductible.

These are all covered services with in-network providers. Why is this not going towards my deductible? My understanding was that only uncovered services or services with out-of-network providers were not supposed to go towards the in-network deductible.

3 Likes
2

Is much of the $900 copays? My insurance does not put copays towards the deductible :upside_down_face:

3 Likes
3

Yeah, this is my thought too. My insurance is amazing and covers almost everything with just a normal visit or specialist copay so I almost never hit my deductible. The only we do hit deductibles is if we have surgery or an MRI. For those things we have to pay our deductible + the copay, and then once we’ve met the deductible it is just the copay.

2 Likes
4

Some of the $900 is a straightforward copay – like a $35 charge for a specialist visit, and it makes sense (ish) that that doesn’t go towards deductible.

Some of the rest is not obviously a co-pay; it’s a portion of e.g. labs/ultrasounds that are hitting my pocketbook. I assume it’s co-insurance? which maybe they also don’t put towards the deductible?

(but also then why am I paying co-insurance before paying the deductible? I’m so confused)

2 Likes
5

I think coinsurance should definitely go towards the deductible, so I would give a call about that! Although I know calling insurance is like the least pleasant experience on earth…

5 Likes
6

cries in American

8 Likes
7

@diapasoun , were you ever able to figure this out?

1 Like
8

…I did not figure it out and basically gave up understanding because insurance.

I hope you’re not also experiencing this.

3 Likes
9

I’ll let you know after we get and pay some more bills in the next couple of months. :expressionless:

1 Like
10

:melting_face: good luck

1 Like
11

Mrs. Benson and I checked out the insurance website the other day, and it looks like we’re not experiencing the same problem as you did. We’re getting very close to our deductible, and a quick back-of-the-napkin calculation shows that if anything we’re paying in bills isn’t being applied to towards the deductible, it’s a very small amount.

I’m still very curious what happened in your situation. In a bad year, that could really hurt you quite severely!

1 Like
12

Check your plan booklet- there will usually be a star for what is and isn’t towards deductible. Copays and some coinsurance isn’t for me

1 Like
13

Lol like I got a plan booklet :joy:

14

It’s on your insurance website or in your HR portal if you get it through work!! I check it all the time :sob:

2 Likes
15

It is not easily available through the HR portal.

Maybe through the insurance website …