Reply to Does anyone get their SN Child his own Insurance Policy on the ACA Exchange?

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Reply to "Does anyone get their SN Child his own Insurance Policy on the ACA Exchange?"

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[quote=Anonymous][quote=Anonymous]Our CareFirst plan from the exchange only covers what they consider “usual” fees…  so for example when our psychiatrist charges $225 our plan finds the “usual” fee for that code, for our region, to be something like $75 so that’s all we get reimbursed for. Rest is out of pocket.

So unless all your providers are processing the insurance and agreeing to your insurers rates, you will be disappointed.

We have the 2nd most expensive out of the 4 tiers of plans. The good part is that yes once our kid hits his personal deductible ($1000, which pretty low) things are covered… but “covered” for $75 on a $225 appointment is not amazing. For our child’s other provider, a social worker, we get more like 40 percent of the cost covered compared to 30-ish percent for the psychiatrist.

I don’t know how they determine these rates but they aren’t what you really pay.[/quote]

I’m totally tracking, but how does the out of pocket max factor into this? If they’re only covering $75, what does that mean about all the $ I’m “out of pocket”?[/quote]

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