And God-forbid you use a narrow network plan like an EPO because it's hard to figure out ahead of time what services are covered by the network and what's not. I went to see a doc who was in-network and only paid a $25 copay, which was great, but the lab where my routine blood work was sent was NOT in network and now I'm looking at $1,000 in lab bills for a test I didn't ask for.
But if the provider can't communicate with the insurance in order to figure that out, why would a different deductible/coinsurance change that?
I was actually told that I met my deductible in 2022, and then I got another big bill in the mail. So that made me think deductibles are a scam and I should just pick the plan with the lowest premium.
(Thanks a lot for answering my questions by the way!)
So some aspect of the coverage might be a 20% coinsurance, where you pay the full cost up to the deductible and then pay 20% of the cost after that until you have reached the out of pocket maximum.
Most of the fees you pay count against both of them, so like if you pay $35 to visit your primary care doctor, you are $35 closer to meeting your deductible, and then also $35 closer to reaching your out of pocket maximum. Lots of frequently used services are covered as a fee based co-pay rather than as coinsurance.
If you have a major expense for something that is covered as 20% coinsurance, the amount up to the deductible would be 100% out of your pocket, and then the coverage would kick in and pay for 80% of the rest (until your 20% exceeds the out of pocket maximum).
I kind of wonder if disallowing insurance companies to negotiate deals with providers would actually end up improving things a lot (because it would create pressure to normalize prices vs fucking around to save a little bit).
Most providers do communicate with the payor and have a decent idea of what you owe, so I was being a bit snarky there. If they know you have a zero copay, you make no payment on site with no follow up bill afterwards.
If, however, if you have a situation where you are using co-insurance (you pay x% and the insurance pays 1-x%) the backend bills and related paperwork can be a nightmare.
In terms of quality I'm really talking about the plan design moreso than the insurer and I'm really talking about a benefit rich plan, which is always going to cost more (and a lot more upfront).
If you have sufficient cash flow and savings to afford out of pocket maximum (usually $10k or so for a family), and you can max out contributions to an HSA, it is always advantageous to opt for an HSA eligible plan (which are legally defined as High Deductible Health Plans, but they will say “HSA” in the name of the plan).
This is due to the triple tax advantages of an HSA, which surpass any other type of investment vehicle.
Why would the size of the deductible/copay affect the amount of paperwork? My naive assumption would be that the amount of paperwork would be O(1) with respect to the amount of money changing hands -- same way you will always be asked if you want a receipt in a store, regardless of how much stuff you bought.
Also, how do I know if an insurer is "high quality"? Neither Aetna nor United is available in my state.
(Thanks in advance for any replies -- I still have about 3 days during which I can switch my insurance for 2023; was thinking of switching to a high-deductible plan since I don't anticipate using my plan much in 2023)