this post was submitted on 04 Sep 2024
56 points (100.0% liked)

No Stupid Questions

35807 readers
1541 users here now

No such thing. Ask away!

!nostupidquestions is a community dedicated to being helpful and answering each others' questions on various topics.

The rules for posting and commenting, besides the rules defined here for lemmy.world, are as follows:

Rules (interactive)


Rule 1- All posts must be legitimate questions. All post titles must include a question.

All posts must be legitimate questions, and all post titles must include a question. Questions that are joke or trolling questions, memes, song lyrics as title, etc. are not allowed here. See Rule 6 for all exceptions.



Rule 2- Your question subject cannot be illegal or NSFW material.

Your question subject cannot be illegal or NSFW material. You will be warned first, banned second.



Rule 3- Do not seek mental, medical and professional help here.

Do not seek mental, medical and professional help here. Breaking this rule will not get you or your post removed, but it will put you at risk, and possibly in danger.



Rule 4- No self promotion or upvote-farming of any kind.

That's it.



Rule 5- No baiting or sealioning or promoting an agenda.

Questions which, instead of being of an innocuous nature, are specifically intended (based on reports and in the opinion of our crack moderation team) to bait users into ideological wars on charged political topics will be removed and the authors warned - or banned - depending on severity.



Rule 6- Regarding META posts and joke questions.

Provided it is about the community itself, you may post non-question posts using the [META] tag on your post title.

On fridays, you are allowed to post meme and troll questions, on the condition that it's in text format only, and conforms with our other rules. These posts MUST include the [NSQ Friday] tag in their title.

If you post a serious question on friday and are looking only for legitimate answers, then please include the [Serious] tag on your post. Irrelevant replies will then be removed by moderators.



Rule 7- You can't intentionally annoy, mock, or harass other members.

If you intentionally annoy, mock, harass, or discriminate against any individual member, you will be removed.

Likewise, if you are a member, sympathiser or a resemblant of a movement that is known to largely hate, mock, discriminate against, and/or want to take lives of a group of people, and you were provably vocal about your hate, then you will be banned on sight.



Rule 8- All comments should try to stay relevant to their parent content.



Rule 9- Reposts from other platforms are not allowed.

Let everyone have their own content.



Rule 10- Majority of bots aren't allowed to participate here.



Credits

Our breathtaking icon was bestowed upon us by @Cevilia!

The greatest banner of all time: by @TheOneWithTheHair!

founded 1 year ago
MODERATORS
 

Say my deductible is 1500 and I need a procedure that’s costs $1000 but my insurance will cover 50% before deductible. A few months before the procedure I managed to meet my deductible though does that mean they will cover 100% of it or the 50% still?

If possible try to explain like I’m five

you are viewing a single comment's thread
view the rest of the comments
[–] xmunk@sh.itjust.works 2 points 2 months ago* (last edited 2 months ago) (1 children)

For bonus points let's also assume that the user is 2100 away from their lifetime cap in scenario three: then instead of you and your insurer splitting the 1k bill evenly your insurer would split 800 with you (400 from each of you) before saying "peace bro im out" and leaving you with the remaining 200 dollar bill.

Additionally the user above was assuming that insurance would cover half the bill - that's actually a variable that your personal plan might disagree with called your "coinsurance" rate, you could have a 50% coinsurance rate, an 80% rate (an awful plan) or a 0% rate which would mean you're fully covered after you hit your deductible (assuming there aren't any annual coverage cap shenanigans).

Also fun is out of network stuff, different plans may vary but let's take scenario three again but assume the HCP you went to was out of network and their charge master (see parent's footnote) says the actual raw cost of the procedure is 23,000 dollars. Your insurer might handle this in two ways:

  1. "get fucked" - your insurer offers no coverage at all for out of network charges - in this case the 23k bill goes against your bank account directly and you likely end up declaring bankruptcy or delinquenting on the loan.

  2. "get (slightly less) fucked" - your insurer looks at what you would have paid at an in network HCP and partially pays for your procedure assuming you had it done at an approved HCP. In this case your insurance pays 500 and you just need to cover the remaining 22.5k... so you once again may consider bankruptcy.

In both cases, for shits and giggles, this extreme medical cost does not count toward your OOP - except for 1000$ in the second case if partial coverage is awarded. This is why people Uber to specific hospitals after traumatic injuries.

[–] ChaosCoati@midwest.social 5 points 2 months ago

All very valid points and part of why American health insurance is such a joke

I had an incident recently where my spouse had to go to the ER because of a life threatening incident. One of those fix it right now or they might die things. (They’re fine now, thank goodness.)

We went to an in-network hospital and all doctors were also in-network. However the one who actually did the life-saving procedure was a specialist. Under our insurance plan seeing a specialist requires a referral, which of course we didn’t have time to get. So insurance tried to nope out of that doctor’s entire bill.