Hi Everyone!
I have a question, but I am going to be slow to the "point"..lol.
We got our new insurance cards today!! They will be effective on 8/01/05!! YAY!!! BUT I am kinda confused!
See I live in Alabama, but the BCBS insurance hubby's work offers is from Tennessee. I went to their website today and we are no where in their network!
What I want to know from all you out there with in-network insurance, what exactly does in-network do? What happens when you are out-networking? We do have the PPO as well. Which I am at a total lost to what that means.
We did not have to deal with in-network and out-network with hubbies other insurance from the other company he worked for.
I am kinda happy to have insurance finally, but not if it is going to cost just as much to go get treated for my RA as if we did not have insurance. I will be more happy when I find out just how this insurance is going to workout. I do not want to have to pay for my labs, x-rays, and anything else. I did not have to with my other insurance hubby had so I hope this is true with this insurance as well.
Many of his co-workers say it is better than the insurance we had before, they are all workers that worked where hubby use to work as well. So, I am hoping this is true.
If not I will not seek treatment. Because I know how much my labs cost and we do not have the money to be dishing out. We are really struggling with money. Within the next 2 weeks we have to come up with money for our daughter's school registration fee 0+, make car payment 5, and trailor payment 0. Hubby does not bring home but maybe 0 - 0 every 2 weeks. He only gets paid .75/hr.
I try to cut back on things. So, we will have money to pay our bills. BUT hubby is compulsive. He will spend before he thinks of his bills.
I feel very helpless, because I am unable to work. Even if I decided that I could work and actually found a job that was not much stress on my RA, I would still have the problem of someone tending to Andrew. If I put him in daycare I will be working just to pay for him to go to daycare. That is why I did not work when MaryBeth was a toddler, because I would be paying for her daycare which would take probably most of my check, because I would not be able to find a job that pays more than /hr.
I have no true skills or education. Just a plain ol' high school diploma. Which people say if you have your HS Diploma you are likely to get a better job, yeah if this was the 1950's!! Now you have to have college, and well I do not think I can actually get thru a college course. I just barely made it thru HS. I hate to read, kinda ironic huh? I am a member of a message forum...lol. But I do not read all the posts at one time and not all of the replies. That is why I am on here so many times thru the day, I am catching up on posts. Another reason I do not like to read is because I have a hard time comprehending what I am reading. I have always been a "weak reader".
Sorry to make this so long and wondered off my question, but it all runs together...and I needed somewhere to vent my "worries" since hubby does not really care or want to understand my worries I have. He thinks everything is ok or will work out. He is so full of himself. If it wasn't for me we would have less money and bigger utility bills. That is the only reason everything "works out". Because I monitor what we spend and I monitor the utilities.
Oh well, I hope ya'll will have an answer for my question.
Thanks Guys!
If you go to an In-Network provider you only pay the co-pay. (maybe ) The doctor must be in the plan and would be considered a "participating physician".
If you have the PPO you can go Out- on Network which means you can see any doctor you want to. These doctors would be considered "non participating doctors". You will be responsible to pay 70% of the "reasonable and customary" (R&C) charge. Be careful with this. Most doctors that are out of Network do not charge "reasonable and customary" fees. Example; Doctor charges 0 for visit. The insurance company determines that the R&C for this visit is 0. Your insurance will pay 70% of the 0 or toward the bill. YOU will then be responsible to pay the balance of 0.
Try to stay with a participating doctor. If you need to go out of network to get the proper care remember this. You can discuss/negotiate the charges with the doctor. Explain what type of coverage you have and ask them what they will accept. After all they want customers (patients) too. And contrary to what some beleive, most doctors are in it for the mula....
Good luck.
Hi Joonie Girl. You write so well. I am surprised you "barely made it thru HS".
I don't know anything about your kind of insurance but it does seem like you would qualify for state medical insurance with your low income. I live in CA and many people use "medi-cal" to supplement what their insurance does not pay. Have you looked into that?
I have a favorite Lyle Lovett quote:
"Men always want to do the right thing - they just need a good woman to tell them what that is !!!!!! "
Deductibles:
Family in network 0
Family out of network 00 (what does this referr to?)
Co Insurance 80/60
PCP Office Co Pay
Specialist Office
Inpatient Hospital Co Pay -
deductible + Co Insurance
Outpatient Hospital -
deductible + Co Insurance
Out of Pocket Maximum -
Family in network 00
Roxy- Well, I did not do that bad in HS. I made mostly C's in classes that had a lot of reading such as English, science, history and Driver's ED...LOL. I made A's & B's in keyboarding, Accounting, & Math.
I type Mother-in-laws reports and & reviews for her college course she taking. And when I am finished typing it she will ask me what i thought of it. And I tell her I do not know? and she will ask why and I will tell her because I did not read it. she wonders how I type something and not read it. Well, it is very easy...lol. I do it all the time. I read it, but I do not retain it. I just type the words in the order they appear on the paper. I do not really read it. I type 35 wpm if my fingers are not stiff, which seems like they are all the time now. All I know is I am typing letters to form words..lol. I do not read her papers.
Jooniper--
Surely, BC/BS has an 800 number you can and ask all your questions. Just tell them you're new to the whole thing. They're usually pretty helpful and patient. The thing is, BC/BS has so many different plans. We can't be sure of what we tell you without reading the details.
It appears you can go to any doctor you want, but you pay a higher percentage if you go to a doc who is not in the network. And either way, you pay for a doctor visit, usually up front. And there may be in-network doctors in Alabama. Seems to me it shouldn't matter where hubby works, but where you live. Call them. They can probably even tell you who is a participating physician in your area. And answer all kinds of "what if" questions you may ask. I have BC/BS, but it's for government employees--they have different rules for each plan.
Ok thanks Sara. I will look into calling them. I tried to access it on the internet thru their website, but I have to wait 3 - 5 business days before they snail-mail my pin.
We have NO particpating docs in this area. we are too far south.
Family in network 0 - is the total amount you must pay out of pocket before any in in network insurance kicks in.
Family out of network 00 (what does this referr to?) - is the toal amoount you must pay out of pocket before any out of network insurance kicks in.
Co Insurance 80/60 - not sure?
PCP Office Co Pay Primary Care Provider PCP is the doctor or gatekeeper you must see before you do anything else. He/she will then refer you to a specialist.
Specialist Office - is the specialist co-pay. The money you pay when you go to the visit.
Inpatient Hospital Co Pay - is your co payment
deductible + Co Insurance
Outpatient Hospital -
deductible + Co Insurance - is your co payment
Out of Pocket Maximum -network 00 - this is the most you will ever have to pay in a year for in network care.
I hope this helps.
Thanks Marcel for the explainations! I now kinda have a better idea of what this insurance is about. I am still a lil' confused but I will call the 1-800# to see if they can answer some of my questions.
Thanks for the help! Your the best!
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