So upset about this stupid cost

[Anonymous]

Anonymous wrote:I find new doctors—MDs—love referring to specialists and ERs. They’re clueless. Give me a nurse practitioner any time.

[Anonymous]

[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]Did you know he was going to ER? The Urgent Care doctor "recommended" right. It was your/your kid's call to go. [/quote]

I knew he was going where the guy recommended. My da actually asked about cost he said and the guy said it would be a copay. I’m not there so I was not going to tell him not to get medical attention after doctor said go to ER and he might go deaf! If he were home we’d have done things differently. In any case I still don’t get why this is not a copay because we do have an ER copay and I’ve never had a copay not kick in before deductible.[/quote]

I’d follow up with your insurance before paying 2k.[/quote]

Insurance are the ones saying it will be full pay bc we have not met deductible, which does not make a lot of sense due to copay.[/quote]

Right, it goes towards your deductible. I get it, but it’s really more of a problem with insurance companies and the high costs of healthcare. I had to get a breast biopsy this year because the doctors said I might have cancer. Turns out I don’t, but I still had to pay for the procedure (more than your son’s ER bill) because I hadn’t met my deductible. I don’t see how you’re getting out of this one. [/quote]

It’s just not clear to me how it’s not just a copay bc my plan lists a $150
Copay and nothing about having to meet deductible first. [/quote]

Do you know how insurance works? Sounds like you really don’t understand your plan. Every plan usually has a deductible. [/quote]

When your plan has copays, that is often the only thing you pay unless separate services were rendered, even if you have not met your deductible. See for instance a derm visit with mole removal: if you have a specialist copay, you pay your copay which covers the removal as well as the visit, and then will have a separate lab fee for the pathologist.

[Anonymous]

When your plan has copays, that is often the only thing you pay unless separate services were rendered, even if you have not met your deductible. See for instance a derm visit with mole removal: if you have a specialist copay, you pay your copay which covers the removal as well as the visit, and then will have a separate lab fee for the pathologist. [/quote]

This is incorrect. I can’t believe so many people don’t understand what a deductible is and when copays apply.

[Anonymous]

[quote=Anonymous]

When your plan has copays, that is often the only thing you pay unless separate services were rendered, even if you have not met your deductible. See for instance a derm visit with mole removal: if you have a specialist copay, you pay your copay which covers the removal as well as the visit, and then will have a separate lab fee for the pathologist. [/quote]

This is incorrect. I can’t believe so many people don’t understand what a deductible is and when copays apply.

[/quote]

it is absolutely correct, in my extensive experience with my own plan.

[Anonymous]

The system is broken AF.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Urgent care is useless. He needs a primary care doctor by the school.

this.

When are you able to see a primary care doctor same day? I’ve never been able to.

Some PCPs reserve time in their days for urgent visits. Mine does. I left a previous practice that didn't.

[Anonymous]

[quote=Anonymous][quote]
When your plan has copays, that is often the only thing you pay unless separate services were rendered, even if you have not met your deductible. See for instance a derm visit with mole removal: if you have a specialist copay, you pay your copay which covers the removal as well as the visit, and then will have a separate lab fee for the pathologist. [/quote]

This is incorrect. I can’t believe so many people don’t understand what a deductible is and when copays apply.

[/quote]

DP. I understand this in theory, but in practice, my insurance has never invoked the deductible unless it was a HDHP. My BCBS plan supposedly has a deductible, but I only ever get charged copays if I go in network, and the brochure has a copay listed for ER visits, so if I get stuck with the full bill for the ER visit because of my deductible, I would be completely confused and annoyed like OP.

[Anonymous]

We are under a high deductible insurance plan. I always tell my doctor this, and frequently they will change their minds about needing to see a specialist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would be more worried about why an adult is getting repeated ear infections! This is worrisome. Does he swim? Do the bacterial infections come on the heels of other, viral, infections like colds and flu? Are the infections usually triggered by wax blockage?

My son is prone to ear wax blockages and there is an oil he has to use regularly to keep the wax from blogging his ear canal. When he forgets for long periods of time, he can't hear, it gets painful, and he ends up needing to see the ENT to remove the wax, which isn't ideal.

He had the flu earlier in year and now a bad sinus infection He already has special drops. And he does get wax build up. Had he been home we would have gone to ENT.

See about getting him set up with an ENT where he goes to college. I've had good and lousy luck with UC, it's a crap shoot. When I do go to a UC I go to one that is part of my heralthcare provider system, even though the hours it's open suck. When I've had bad luck (like when UC prescribed wrong antibiotic for an episode of recurrent MRSA I had a well documented history of so no, Keflex was not the right choice and it lost a day of treating the infection--wouldn't have asked why he didn't give sulfa or clindamycin like they normally did but I was in too much of a fever and low bp fog to open my mouth) they have given me a credit for the copay since I had to go back and catch a different UC doctor.

[Anonymous]

[quote=Anonymous][quote=Anonymous][quote]
When your plan has copays, that is often the only thing you pay unless separate services were rendered, even if you have not met your deductible. See for instance a derm visit with mole removal: if you have a specialist copay, you pay your copay which covers the removal as well as the visit, and then will have a separate lab fee for the pathologist. [/quote]

This is incorrect. I can’t believe so many people don’t understand what a deductible is and when copays apply.

[/quote]

DP. I understand this in theory, but in practice, my insurance has never invoked the deductible unless it was a HDHP. My BCBS plan supposedly has a deductible, but I only ever get charged copays if I go in network, and the brochure has a copay listed for ER visits, so if I get stuck with the full bill for the ER visit because of my deductible, I would be completely confused and annoyed like OP. [/quote]

The insurance I had before I retired had deductible only for hospital stays, not outpatient care or prescriptions--and that was through multiple policies since my employer changed almost every year. I was only hospitalized once in 15 years working there so even though my deductible was on the high side it was never an issue for me. Even when we had United/Caremark.

[Anonymous]

It sounds like OP does not understand their plan. Even “regular” copay style plans are imposing deductibles now in an effort to manage costs and steer patients away from going to the ER for things like ear wax buildup. (Sorry OP, I know you’re frustrated, but this is exactly why this is happening). What happened last year or on another plan is irrelevant to what your plan this year provides.

How it works is you pay your deductible in full first, then your co-insurance/copays apply for any visits your son might need to do later in the plan year.

You may or may not need to pay deductibles for everyone in your family. I’d suggest you get a summary sheet from your benefits department so you know exactly what is required under your particular plan.

[Anonymous]

Anonymous wrote:It sounds like OP does not understand their plan. Even “regular” copay style plans are imposing deductibles now in an effort to manage costs and steer patients away from going to the ER for things like ear wax buildup. (Sorry OP, I know you’re frustrated, but this is exactly why this is happening). What happened last year or on another plan is irrelevant to what your plan this year provides.

How it works is you pay your deductible in full first, then your co-insurance/copays apply for any visits your son might need to do later in the plan year.

You may or may not need to pay deductibles for everyone in your family. I’d suggest you get a summary sheet from your benefits department so you know exactly what is required under your particular plan.

I'm op and no, this is not what happened: My plan - on the insurance site I always check to see who is in network, what copays are - lists copays for various visits including the ER. It is a very simple list, they are all listed together with zero mention of deductible. I have had many visits this year under this plan (my plan starts in June so it has been many months and all these claims are done, processed) and so have other family members: to PCP, specialists, urgent care/minute clinic, telehealth...All resulted in JUST a copay being paid, no deductible to be reached first before copays kicked in. So I assumed that as the ER was listed right along with the others, exactly the same way as the others, it meant it was the same.

When I went to the full brochure for my plan through my employer however, they had the same breakdown of various copays but added "deductible waived" next to PCP, specialists and urgent care and did not add it for ER. THAT is my mistake: I trusted the quick summary on the website and assumed that all the various visits listed along with their copays had the same set up. I should have checked, but I also think there is a defect here in not adding "deductible waived" for the quick summary which is what most people check. Info should look the same across all documentation.

[Anonymous]

If one has chronic excessive ear wax, then one should use (non-prescription) Carbamide Peroxide solution regularly inside the ears. This might tingle after it is in the ear canal, which is an indication it is working. When that solution hits ear wax there is a mild exothermic reaction.

Also, when washing hair, put a little of the shampoo suds in the ear canal to help clean it, and also rinse/wash the hair with colder water. Warmer water on/near the ears often increases ear wax production.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It sounds like OP does not understand their plan. Even “regular” copay style plans are imposing deductibles now in an effort to manage costs and steer patients away from going to the ER for things like ear wax buildup. (Sorry OP, I know you’re frustrated, but this is exactly why this is happening). What happened last year or on another plan is irrelevant to what your plan this year provides.

How it works is you pay your deductible in full first, then your co-insurance/copays apply for any visits your son might need to do later in the plan year.

You may or may not need to pay deductibles for everyone in your family. I’d suggest you get a summary sheet from your benefits department so you know exactly what is required under your particular plan.

I'm op and no, this is not what happened: My plan - on the insurance site I always check to see who is in network, what copays are - lists copays for various visits including the ER. It is a very simple list, they are all listed together with zero mention of deductible. I have had many visits this year under this plan (my plan starts in June so it has been many months and all these claims are done, processed) and so have other family members: to PCP, specialists, urgent care/minute clinic, telehealth...All resulted in JUST a copay being paid, no deductible to be reached first before copays kicked in. So I assumed that as the ER was listed right along with the others, exactly the same way as the others, it meant it was the same.

When I went to the full brochure for my plan through my employer however, they had the same breakdown of various copays but added "deductible waived" next to PCP, specialists and urgent care and did not add it for ER. THAT is my mistake: I trusted the quick summary on the website and assumed that all the various visits listed along with their copays had the same set up. I should have checked, but I also think there is a defect here in not adding "deductible waived" for the quick summary which is what most people check. Info should look the same across all documentation.

DP. Ugh, that sucks! I'm glad you finally found an answer though. I would have assumed the same as you. That's kind of deceptive. Now I'm curious to look at mine. Was this BCBS basic? It also sounds like they would make you pay the deductible for any ER visit, even one which would have been necessary.

[Anonymous]

Anonymous wrote:I find new doctors—MDs—love referring to specialists and ERs. They’re clueless. Give me a nurse practitioner any time.

Funny. . I’ve had the exact same experience with nurse practitioners! I’ll take a seasoned physician over an NP any time.