Recent Visit to the Emergency Room

Well...not so recent as I am late in keeping up with updating our BLOG.

Back in August I had cut my finger with a knife when I was packing up my apartment.  There was no to much pain but a whole lot of bleeding.  After 20 min of continuous bleeding I decide to visit the Emergency Room (ER) as it was during the middle of the night.

Living in the Gold Coast I chose to visit St. Joseph's which is Resurrection HealthCare.  I was treated right away and during my 45 minute stay I received gel foam to help coagulate the blood on the cut, which was wrapped up with a band-aid.  I was then visited by a physician who went over the gel foam and told me to keep it on for 24 hours and then let it heal naturally.

Two weeks following my visit I received a bill from Resurrection HealthCare for $1072.50 which was for Facility Emergency Services.  The next day I received another bill, this time for Physician Services which was for $196.  This brought my total bill to $1,268.50.

$1,268.50 is the retail cost and is the cost one would be responsible to pay if not covered by health insurance.

Being self-employed I have private health insurance coverage with Blue Cross and Blue Shield of Illinois (BCBSIL), in which I presented my insurance card at time of service.  The plan I have is HSA compatible with an annual $2,600 deductible then 100% coverage after. My plan design leaves me to pay up to the my deductible before BCBSIL is to pay a percentage or all.

Back to the bills....

Once I received all billing from Resurrection I then received two Explanation of Benefits (EOBs) from BCBSIL that went over my recent visit, costs and then showed the allowable amount I was to be billed for these services.  The "allowable amount" also known as the "negotiated/contracted rate" is the amount the provider (Resurrection) is allowed to bill me since they accept BCBSIL and are considered an "in-network" provider.

Another week went by and I then received updated billing from Resurrection requesting the reflected amount on my EOBs.  This final amount is what I owe to the provider and is applied towards my deductible.

The final costs were $521 for Facility Services and $56 for Physician Services, $577 total. This is how health insurance works! 

No matter what my plan benefits are compared to anyone else with BCBSIL this would be the plan members responsibility prior to their plan benefits.

Now....the final thing to discuss is how the plan design of my HSA compatible plan works.  The plan requires that I meet the first $2,600 before BCBSIL is to pay 100% of all remaining calendar year expenses.  I take a monthly medication that costs $46 each time at Walgreens, totaling $552/year that is applied toward my deductible.  With the above ER expense I have applied a total of $1,129 toward the plan deductible.  This leaves me knowing that if anything major happened to me, I would only owe a remaining $1,471 before BCBSIL is to pay 100%.  For the price I pay in premium, I don't find a high deductible plan of coverage without copays to be too bad.

Hope this helps in making a decision towards purchasing a plan or understanding how a plan of coverage works.

Thanks,

-The Shoppe

sliw afternoon and vail kills time at the shoppe

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What does having a low deductible mean?

When referencing a low deductible it is in the line of $500 or $1,000.

These are most likely found when coverage is being provided through your employer.

Having a low deductible only means that you are paying a lower amount prior to your insurance carrier paying a percentage (coinsurance) in which you pay your percentage share towards the plans out-of-pocket expense limit in addition to your plans deductible.  Any copays do not apply to the plan deductible or out-of-pocket.

A lower deductible will come into play better than a high when looking at outpatient procedures that total from $500-$2,000

When faced with a large claim such as hospitalization than a low deductible plan will pay them same when comparing high deductible plans, $2,500 or above, especially with 100% coverage after the high deductible,  The main note is that the higher deductible plan can cost anywhere from 30-40% lower in monthly premium.

When choosing to pay the premium for a low deductible, the insured is making the choice in paying upfront to pay less at time of service.  When choosing a higher deductible, especially HSA compatible, the insured is saving in premium and self insuring themselves for small expenses such as office visits.

Please contact the shoppe with any questions.

-The Shoppe