[quote name='Kendro']If I break my leg and you fix it, ballpark estimate, how much would my bill cost if you include all normal procedures and services?[/QUOTE]
I am sure any doctor may differ on this opinion, but that is one huge advantage to health insurance..
If you have insurance you typically have a negotiated discount on the services. The doctors join "networks" and then agree to only charge so much for procedures, if their typical rate is higher you get a network discount,a nd they write off their charge above the contracted allowance.
I cannot stress enough that even if you have a high deductible plan of $5000 how much you will save in reality.
I'll try to keep this short. I had a group that decide on what they could afford to offer the employees was.
$7500 Deductible
50% Coinsurance for an additional $5000*
Discount Drug Card
$35 office visits
Urgent Care - Applies to Deductible/Coinsurance (no flat copays)
Emergency Room - Applies to Deductible/Coinsruance (no flat copays)
*Coinsurance- This is after deductible what you split "Coinsure" with the insurance company, This amount stops at a certain "stop Loss" or "Coinsurance Max" or "out of pocket maximum", then the plan pays 100% thereafter for a year per person in a family
So a single person on that plan, looking at a high level, would potentially owe $7500(deductible), then split the next (Coinsurance) $10,000 50% (Employee) /50% (Insurance Carrier) meaning they paid $5k of that. So they would be on the hook for $12,500 in any given year... ($7500 + $5000) That does not include office copays, RX, etc. Broad picture here.
So this plan was previously a $2500 deductible, but the owner moved it to a $7500 deductible (per person remember) for a monthly savings of $200 for his business. He had 10 employees, his shift of $5000 per employee for that small of savings was crazy, and I basically told him so.
Fast forward to 14 months later, an employees 11 year old son has an appendix rupture.. $35,000 bill.
Of that bill it got reduced to $19,000 just with the network discounts, again the negotiated write off the doctors had to take by joining that network. Then he owed $7500, and of the remaining 11,500 he owed $5000 and maxed out for the year (now that child is covered 100% for the rest of the year.)
$35,000
-$16,000 (Network Discount)
-----------
$19,000
-$7500 (Deductible)
-----------
$11,500
-$5000 (Employees Coinsurance max @ 50%)
-----------
$6500 (Insurance pays)
Yeah $12,500 sucks, but not as bad as $33,000 would have or even say $28,000 or whatever a possible "cash discount" would have brought him to.
The owner called me upset as he didnt know the actual exposure.. I showed him our paperwork from the year prior explaining it and his signature., then he recalled the multiple conversations, and said his employees were mad at him. He wanted to handle it when he returned from an out of state trip and look at alternate plans.
Needless to say the owner had an unexpected ER visit. He is now on the hook for like $10,000. And since he is met his deductible he is not moving the plan as it will cost the company more, we are looking again next year.
It can happen at any point, to anyone, for any reason, and it can literally ruin you life, and finances for the rest of your life.
in' splinter.
So ever since then I've just been going to a local health clinic that's run once a week by the one university here, but only when I'm really sick usually.