"New Health Insurance" not so good when using Emergency Room

[upschuck]

Incorrect. If you have individual coverage, you are the only one covered, your out of pocket limit is $1000. If you have family coverage, spouse, children, your out of pocket maximum is $2000.

It is not defined per person for family coverage. It is the total out of pocket expense for all family members combined that you may have to pay.

You are incorrect.

See where it says "per person" on the Individual out of pocket? What does that mean, if it means what you are saying? No one person can go over $1000, and no family can go over $2000. Mark it down.

 

[Benben]

The Auto Insurance is primary. Health Insurance is secondary. Tell the hospital to submit correctly!

 

[Mugarolla]

You are incorrect.

See where it says "per person" on the Individual out of pocket? What does that mean, if it means what you are saying? No one person can go over $1000, and no family can go over $2000. Mark it down.

If what you are saying is true, why does the OP state that he has already accumulated over $1400 in bills that he has to pay. He went over the $1000 mark per person as you say. His insurance should be picking up anything over the $1000. They are not. And will not until he reaches the $2000 out of pocket expenses because he has a family plan.

It would only be $1000 if he had an individual plan, which he doesn't. No one person can go over $1000 in an individual plan. No family can go over $2000 in a family plan.

In the left column, it says "individual out of pocket maximum." This is the maximum that an individual can pay under the individual plan. $1000.

The other says "family plan." This is the maximum that the primary insured cardholder, you, can pay under the family plan. $2000. All $2000 can come from the same family member. It is not broken down per person for the family plan.

Mark it down.

 

[Mugarolla]

I really did like my avatar, but noticed Dr. Brown was using the same one so I changed mine. She was getting a little old anyway.

 

[BrownDead]

Thanks for the replies. Found out E.R. only covered at 80% now in the Teamster Plan. That stings a little considering the former plan covered E.R. at 100%. My max out of pocket for the year will be 2 grand. Looks like I'll hit that quickly. There are many "Teamster Plans" thru out the country. I'm in Plan U2. I'm thankful to have the insurance, it would have been devastating without it.

 

[Mugarolla]

Thanks for the replies. Found out E.R. only covered at 80% now in the Teamster Plan. That stings a little considering the former plan covered E.R. at 100%. My max out of pocket for the year will be 2 grand. Looks like I'll hit that quickly. There are many "Teamster Plans" thru out the country. I'm in Plan U2. I'm thankful to have the insurance, it would have been devastating without it.

Teamcare is a good plan. It's just not as good as a lot of us had. We took a concession when UPS profits are increasing.

 

[UpstateNYUPSer(Ret)]

Thanks for the replies. Found out E.R. only covered at 80% now in the Teamster Plan. That stings a little considering the former plan covered E.R. at 100%. My max out of pocket for the year will be 2 grand. Looks like I'll hit that quickly. There are many "Teamster Plans" thru out the country. I'm in Plan U2. I'm thankful to have the insurance, it would have been devastating without it.

Have you submitted any of the bills to your car insurance company?

 

[upschuck]

If what you are saying is true, why does the OP state that he has already accumulated over $1400 in bills that he has to pay. He went over the $1000 mark per person as you say. His insurance should be picking up anything over the $1000. They are not. And will not until he reaches the $2000 out of pocket expenses because he has a family plan.

It would only be $1000 if he had an individual plan, which he doesn't. No one person can go over $1000 in an individual plan. No family can go over $2000 in a family plan.

In the left column, it says "individual out of pocket maximum." This is the maximum that an individual can pay under the individual plan. $1000.

The other says "family plan." This is the maximum that the primary insured cardholder, you, can pay under the family plan. $2000. All $2000 can come from the same family member. It is not broken down per person for the family plan.

Mark it down.

From the Teamcare website:

Read the example, it says "Although no individual family member met the Individual Out-of-Pocket Expense Limit of $1000 per person", how do you explain that?

I told him to contact Teamcare as to why he has paid over that amount for one member, and to appeal if necessary.

 

[oldngray]

From the Teamcare website:
View attachment 19013
Read the example, it says "Although no individual family member met the Individual Out-of-Pocket Expense Limit of $1000 per person", how do you explain that?

I told him to contact Teamcare as to why he has paid over that amount for one member, and to appeal if necessary.

I think the situation is he signed up under the family plan to cover everyone in his family so the $2000 is the total for all family members regardless of who was sick. The $1000 limit would only apply if he was under the single coverage option and nobody else was covered.

 

[upschuck]

Have you submitted any of the bills to your car insurance company?

After my sons surgery, their lawyer sent a form, requiring motor vehicle insurance information, so they can collect from them, or reduce the amount they would pay, I guessing. I think they had already paid, if I recall right, so they would then collect from insurance.

 

[oldngray]

After my sons surgery, their lawyer sent a form, requiring motor vehicle insurance information, so they can collect from them, or reduce the amount they would pay, I guessing. I think they had already paid, if I recall right, so they would then collect from insurance.

Insurance companies can be slow to pay. I always ignore the first bill or two I get from a doctor to wait and see how much insurance paid.

 

[UpstateNYUPSer(Ret)]

After my sons surgery, their lawyer sent a form, requiring motor vehicle insurance information, so they can collect from them, or reduce the amount they would pay, I guessing. I think they had already paid, if I recall right, so they would then collect from insurance.

It's called subrogation.

 

[upschuck]

I think the situation is he signed up under the family plan to cover everyone in his family so the $2000 is the total for all family members regardless of who was sick. The $1000 limit would only apply if he was under the single coverage option and nobody else was covered.

He said he was in the U2 plan, which is what mine says it is also(I thought all the new people were in the better plan). I have never signed up for anything in my life for medical, so I could not sign up for individual, if I tried. How do you interpret the example given?

 

[upschuck]

It's called subrogation.

If he was a she, would it be called susisgation?

 

[upschuck]

Insurance companies can be slow to pay. I always ignore the first bill or two I get from a doctor to wait and see how much insurance paid.

Teamcare has always paid fairly quickly for me.

 

[Mugarolla]

He said he was in the U2 plan, which is what mine says it is also(I thought all the new people were in the better plan). I have never signed up for anything in my life for medical, so I could not sign up for individual, if I tried. How do you interpret the example given?

According to the example, upschuck may be right. It seems to say, that even with the family plan, each individual member is subject to the $1000 out of pocket expense and everyone put together is subject to the $2000 limit.

Sorry upschuck, I stand corrected.

 

[upschuck]

He should call Teamcare and get it straightened out.

 

[104Feeder]

A lot of the time it's because of the providers billing improperly. I ran into that issue and it was a case of the Dr. office staff being stubborn and Aetna needing a box checked then everything was paid.

 

[BrownBrokeDown]

According to the example, upschuck may be right. It seems to say, that even with the family plan, each individual member is subject to the $1000 out of pocket expense and everyone put together is subject to the $2000 limit.

Sorry upschuck, I stand corrected.

If you go on the Teamcare website and log on, on the front page you see the amount of OOP accumalated towards the family max. You can go into the Benefit Limits and Accumalations and you can see, per person covered, both the individual accumalation (towards the $1000) and the family accumalation (towards the $2000).

 

[Notcool]

I went to renew a prescription. Doc asked me if i wanted a flu shot. I said sure, thinking it wouldnt cost me anything. I got a bill for $74. Shot was $26 and $48 to administer is WTF