Anyone who has Kaiser (please help)

[RS732]

I am so confused after speaking to 2 separate reps. I was quoted nearly $400 per month for a co-pay 25 plan. I will be starting school this spring and doubt I would be able to afford that plan comfortably.

Could someone please let me know, what plan you have.

I don't go to the Dr's often, are the deductible plans a better route? Do any of the cheaper plans cover the surgery 100%?

I have a week before the deadline. I'm getting bad anxiety just thinking about this. Please help

[davec]

I pay $175/mo for an individual plan (non-empoyer) with a $1500 deductible. Not sure what my plan's called, but my co-pays are pretty high- usually between $70-$100/office visit. Your age will factor into your premium- I'm 31 now but started off paying $120/mo in my 20s.

Had a sarpe 2 years ago and just followed up with orthognathic surgery to both upper and lower jaws last week. In both cases, I paid my entire deductible along with inpatient and Dr's visit co-pays.

[RS732]

How do deductible plans work? Before I go to a office visit, I must pay the $1500 deductible?

Thanks for your help.

[sirwired]

In general insurance terms, a "deductible" is what you must pay before the insurance company will kick in anything. Basically, you pay for the first $1,500 out of pocket, for whatever services it takes to use that $1,500. Unless the first service of the year is $1,500, it might take many office visits before you've paid out your whole deductible. After that, the insurance company pays according to their benefit schedule. Usually, your out-of-pocket copays that you start paying at this point "max out" at some higher amount of money, after which the insurance company pays everything.

[davec]

[quote="sirwired"]In general insurance terms, a "deductible" is what you must pay before the insurance company will kick in anything. Basically, you pay for the first $1,500 out of pocket, for whatever services it takes to use that $1,500. Unless the first service of the year is $1,500, it might take many office visits before you've paid out your whole deductible. After that, the insurance company pays according to their benefit schedule. Usually, your out-of-pocket copays that you start paying at this point "max out" at some higher amount of money, after which the insurance company pays everything.[/quote]

Co-pays and deductible are two separate categories. For instance, I only had to pay up to my max deductible ($1500 in my case) of my surgery, but the co-pay of my hospital stay was $300/day, regardless of my deductible. So now if I have another procedure, I will not need to pay any more $$ since my deductible has maxed out, but co-pays for office visits still apply.

[howen6]

@ davec, who is your insurance provider? Are we allowed to ask that on here? My husband is in need of sarpe and I am looking at individual Insuance plans but need to find one that is known for approving this kind of surgery.