What is your out of network deductible and do you hit it for your kid's services?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Hdhps are intended for normal use to not hit the deductible. The deductible is there for emergencies. If youre hitting, honestly, a PPO is probably a better option.

Not sure about OP but I have a PPO and the out of network deductible is $8000 also. It’s the highest level option we can choose. They just really don’t want to pay for out of network care.

Deductible or out of pocket max? Extremely uncommong for a PPO to have that high of a deductible.

NP. I have a PPO and the OON deductible is $7,500.

[Anonymous]

We have a similar plan. No choice. Employer

[Anonymous]

We always pick the $250 in network and $500 out of network plan. The high deductible is only for healthy people that rarely use insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Hdhps are intended for normal use to not hit the deductible. The deductible is there for emergencies. If youre hitting, honestly, a PPO is probably a better option.

Not sure about OP but I have a PPO and the out of network deductible is $8000 also. It’s the highest level option we can choose. They just really don’t want to pay for out of network care.

Deductible or out of pocket max? Extremely uncommong for a PPO to have that high of a deductible.

Nope, deductible. Trust me, I am very familiar as I have a kiddo with serious mental health issues. In my experience, spouse has worked for several federal government contractor, this is not uncommon. And as I mentioned, the best plan that is offered by this current, very large corporate employer.

[Anonymous]

Anonymous wrote:We always pick the $250 in network and $500 out of network plan. The high deductible is only for healthy people that rarely use insurance.

It’s nice to have that option. We have never had that kind of OON deductible choice.

[Anonymous]

Anonymous wrote:We always pick the $250 in network and $500 out of network plan. The high deductible is only for healthy people that rarely use insurance.

…or for people whose employers don’t offer any other options.

[Anonymous]

I am a lawyer and have worked for 2 different big law firms over 20 years. DH works in financial services and started at the bottom of the totem pole and is now high up, across two different large public companies. Both of our employers have always offered two "health care" options: One is the "gold" PPO where premiums are high ($2500/month per family - in law firms, the lawyer has the pay the whole thing, in the corporate world, they pay for a big chunk of DH's premiums, but adding the family is on us - it's around $1500/month). Our deductible is around $7500 a year. We no longer live in DC. In DC, there are laws that the amount you are billed for medical has to be tied to the insured amount. There are no similar laws where we live. So even when we are in network, insurance paying 80% is only 80% of the approved insured amount, and we still always get a bill for the balance. Might be $25, might be $400. You just never know. And drugs all apply to the same deductible. I don't even bother running therapy through insurance because it's not worth it. We typically reach our deductible every fall, and we are a healthy family with a kid with ADHD but nothing much else going on. More and more, we just pay for stuff out of pocket - my primary care doctor i pay $150 a year for my annual, our pediatrician went concierge and it's just easier to do that. I consider the insurance for emergency/catastrophic things, and the rest we presume we will pay for. As mentioned, this is the "gold" plan at both our employers, and has always been that way. And we are paying $1500 to $2500 for the pleasure of this every month. The other option is typically some kind of health savings account racket where you don't actually have insurance; something that doesn't work for people with kids because the odds are just too great.

I think americans who work for govt or in these other unicorn jobs with true health insurance have no idea how bad insurance has been for so many people for two decades.

[Anonymous]

Anonymous wrote:We always pick the $250 in network and $500 out of network plan. The high deductible is only for healthy people that rarely use insurance.

It is always important to actually run the total annual cost of premiums + deductible or premiums + out of pocket max depending on how healthy one is. In my experience it is almost always better for people with a decent income to pick a high deductible HSA with lower premiums vs high premium low deductible plan that does not have the HSA benefits. Lot of my acquaintances are really focused on keeping deductible low and don't run the numbers and actually end up paying more, but since it comes before the paycheck it seems less painful. I always run the worst case numbers and have that guide me as the result we have low six figures invested in the HSA account that will most likely never get taxed and money going in also never was taxed.

[Anonymous]

We found that a more expensive plan with a more generous definition of what OON charges should be was worth the higher premiums. I have a 'platinum' plan that was supposed to be great, and had a relatively low OON deductible (like 2,000 or so) but they pegged OON charges to Medicare, not actual market prices.
My wife's plan has a similar deductible, but allows $225 an hour for therapy, and our kid's therapist charges $200.