Generally speaking, nurses and doctors don't know or care how much their services cost. That $773 isn't accounted for by my insurance claims/payments. No co-pays, etc? Have a $3,000 out-of-pocket bill from a hospital stay, the plan pays $3,000. Is this a plan with an embedded deductible? Once you've spent 13000 out of your pocket for the year, you will no longer pay for stuff. Now, we pay about $400 a month for really good health insurance … The average health insurance cost for single coverage premiums in 2018 was $440 per month. Are you sure that's really the case? If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. However, there are some occasions when it may actually make sense to pay for medical care out of pocket rather than use your health insurance coverage. I have no idea where to start with that process. Health insurance vs. paying out of pocket. That's the whole reason to have health insurance. This has also (and still does) protect me from fines associated with not having health insurance. Since this was broken while working on my car, the first $2k was paid by the auto insurance. What about those awful things that happen to some of us some times? Quick, precise, and to the point. One has a deductible of $2000 with an Out of pocket max at $8500 for $900/mo. This is not unique to health care. It depends on your company and your coverage. The health system billed more to insurance than it billed me. I've been seen recently by the local hospital once a month for 4 month and was charged $600. Individual deductibles and out of pocket maximums are just that--per individual. By using our Services or clicking I agree, you agree to our use of cookies. I apologize, and have since corrected my explanation. The most common thing I get is "What if there's an emergency?". Turns out, I didn't owe any money for the surgery since I had met my out of pocket max previously. What I'm noticing though is you didn't take into account my special circumstances. I’m just confused, if 100% after 6500 is covered then how would I reach the out of pocket maximum? you pay for all bills till you hit your 6500 deductible. Please contact the moderators of this subreddit if you have any questions or concerns. Ask to speak to someone in the billing department. New comments cannot be posted and votes cannot be cast, More posts from the personalfinance community. Press question mark to learn the rest of the keyboard shortcuts. Is there a process to negotiating with a hospital? The amount the insurance company pays after you meet the deductible will depend on your coinsurance percentage.Let’s say you purchase a health plan with a $3,000 deductible and 20% coinsurance. I just found this out tonight while going through bills and reimbursing myself from my HSA. In my state's Individual market 7% of the people account for 60% of the costs. We buy it for the insurance that if a big nasty thing happens, we won't be ruined. U.S. hospitals keep fees very well hidden from you until you receive a bill, and anytime I've asked for how much something will cost hospital employees have been quite taken aback. If you'd be screwed in those cases, you may want insurance. Cookies help us deliver our Services. Alrighty. I had already paid 100% of my out of pocket, and then in addition paid that $773. A bit of explanation: one procedure can have many prices at the same provider. You receive nothing more, but … You do not receive credit for that $50 to your OON deductible or OON OOP and insurance will never base their payment off the $150, only the $100. Do's and don'ts? Most people who don’t purchase health insurance figure they’ll just pay out-of-pocket if something small, but still unexpected, happens. I was paying $551 a month for catastrophic insurance for my wife and me. 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