So I've figured out from the exchange how to look up things like covers depression maintenance, covers things before you meet the detectable. I even figure out how to see if they will cover out of coverage providers. But I can't figure out how to tell what covering out of coverage providers means! Do they pay only have the detectable? Do I just do the co-pay? Do I have to fight with them over it? I just want to be able to see a primary care doctor when I'm sick and for wellness check ups but unless I can get my therapy and new psych covered (both are in the same office and out of coverage for all insurance since they deal with Autism and do not do ABA) mom thinks me having insurance is too costly and she'd rather pay out of pocket. (spoilers she will never pay out of pocket unless I've been sick for two weeks or more). It doesn't help that Texas didn't expand anything so I qualify for no help even though according to the exchange stuff I make -100 dollars every year.
It depends on the type of insurance you have. Do you know whether it's an HMO, PPO, POS, etc? If you have an insurance card, there's a strong chance it will say one of those things on it. I haven't looked at health insurance exchange stuff enough to help specifically with that, unfortunately.
I don't have insurance. Unless I can convince mom its not a waste of money I will not gave insurance. She'd rather pay out of pocket or make me go to the ER at the hospital that will cover people with no insurance or money. None of the hmo in the price range she will even consider cover out of network. Just ppo I think.
Okay - so are you considering health insurance plans? Is that what's happening here? It would help if you could describe a little more about what you're looking for, I'm a bit unclear what you're asking about.
I want to camp in this thread because signing up for healthcare what. I'm in one of the states has its own plan and site, and I tried signing up during the last open enrollment. It didn't approve me for any of the financial aid options, but it also didn't give me provide me with any health insurance plans that I qualified for. I don't know what to do now.
i had more luck searching by gold/silver/bronze tier than i did anything else. good thing is, i had no providers in this state before i signed up for this insurance, and so i didn't have to worry about my providers being outside of coverage! now i am asking my gp for like twelve thousand referrals lel. i would also recommend comparing plans and how they do medication coverage. i view it as, i'm paying ahead of time in monthly installments for all my durgs. the cost/benefit balances out. also, i had insurance for when i was hit by a car. texas is stupid and i fuckin' empathize, bruh
I'm in Wisconsin, which uses the national marketplace, and my only real experience with admin was Canadian group health insurance. But! I've had to find my own insurance the past couple years, and I've helped a couple other people in state sort things out. Out of network coverage depends on the plan. You can probably go on the provider's website and find out who IS in their network - it's often more comprehensive than you'd think. Often, care that would not be covered will not count towards your deductible. A deductible works like this: it is the max amount you will pay and then they cover everything after that, to whatever your maximum is. Sometimes you will still have dollar-based or percentage-based copays, but basically once you've met your deductible everything is super cheap. Yay! Health maintenance stuff like annual checkups is supposed to be free/super cheap under the ACA even if you haven't met the deductible. There are both tax credits (lowering your monthly premium, apply to all plans) and cost reduction subsidies (lower your out-of-pocket costs, effectively lowering your deductible and copays, only apply to Silver plans), and the tax credits at least are federal and so should still be available in Texas. If there is straight-up nothing you can afford, you probably qualify for Medicaid! Yay. Try to apply for that. There is a fine for not having health insurance. In 2016 it's going to be $695 per adult, levied when taxes are filed. Holy shit, get insurance during this open enrollment period.
caveat: i tried to apply for medicaid/medicare, and even though i had a grand total of expected income of $0, i still didn't qualify. i got an official rejection letter and everything! it was very exciting. texas in particular is getting Very Stubborn about medicaid/medicare, because of the ACA and not wanting to do what the feds tell them. it was getting to the point where they were about to reject their federal funding for those programs because they'd rather say "nuh uh" to d.c. than help their own citizens. great jorb, tx.
I know I have no right to comment on this, probably, but, sometimes you country seriously does not make sense to me at all. What you just described seems petty and vindictive and not in the best interest of anyone. I though politicians were supposed to be for the people?
We live in Hell. Texas is like Extra Super Capitalist Hell, and I am sorry for those of you who live in it.
Okay: what I need to know - How do I tell what the cost will be for out of network. That is all I need to know. If it is against the deductible I am not allowed to have insurance. My mother will not pay for me to have insurance of any type at all unless it covers my thearpist and pysch without having to meet the detectable first. She does not care if it will cover my meds. She does not care if it will let me go to a doctor and have a wellness check for the first time since I was 22. She does not care. IF it does not pay for the therapist and Psychiatrist, it would be too much and she cannot afford it (she can afford it, she just thinks the state should pay for me,) She will also not consider any plan above 300 dollars. My Therapist and Pysch are out of network for ALL insurance. I cannot through no amount of digging and look out brouchers find out what out of network costs. I have a list of ones from the exchange that will cover out of network but they do not say what the cost is. I tried calling one to just ask, was on hold for half an hour and had a panic attack. I was trying to leave a lot of the mom stuff out of this since this is just general advice, and I just wanted to know how to tell what out of coverage costs.
Okay, for that specific problem: I'm guessing you don't qualify for the cost-sharing bit, so that's out (if I'm wrong, then that opens whole new avenues). For out-of-network providers, there should be a breakdown available of what they cover and what co-pays would be. If you only have access to long detailed crap rather than simple color-coded tick boxes (which are the best and my preferred data presentation), upload or send me a PDF or link and I can probably break it down. My plan offers zero coverage for out-of-network, which means your mom would opt for paying a fine rather than letting you be healthy (which strikes me as insane, but, y'know, her call). If a plan offer partial coverage, it could be either a percentage or work out to be a flat rate, and should say so. At that point, you'd need to know what your therapy appointments costs. Some plans will have complete coverage out-of-network if it's with specialists. Most of them will still need you to meet a deductible, but, like, you end up paying for an appointment and then the rest are free or super cheap?????? That's pretty good???????????
from what i can remember, every policy in the marketplace has a pdf document you can look at to see what costs are what. you can also visit the individual provider websites (e.g. bcbstx.com or whatever) to see the more detailed 100-some page pdf. basically "jump through every single hoop there ever is. then do it again." fuck, and i need to look up what my policy's changing into.
I'll pull up the pdfs again and post them, but the ones that did seem to cover had "No charge" if I remembered right in the boxes were copays were normally listed? My mom said that meant they went against the ductuable and therefore the policy wasn't worth it (I can't get through to her that my meds being paid for completely or for a tiny copay would be worth it *sighs* maybe she'll change her tune when I she sees the cost tuesday). Sorry ,if I came off snapish and ungrateful, the start of my day was rather distressing and this whole thing is frustrating because she doesn't seem to think that me being 35 (I keep trying to make myself 36, though I swear I should be allowed to declare the last decade as didn't happen and be 25, I feel it) and not having had a wellness check since I was like 22 is a problem.
Nah, @Kijikun, this whole thing is understandable stressful! And . . . does your mom understand what the deductible is? Like, I am well aware that as a Canadian socialist I have very different views on a lot of things, but I would think, if the copays do count towards the deductible, 'small payments that count towards the limit after which everything is free' would be a good thing???????? And I really hope you can get a wellness check soon. :(
My mom thinks if she has to pay for any appointment fully out of pocket for me then it is not worth paying for the insurance and she'd rather pay it all out of pocket. Because you see to her paying 320 a month for two/three appointments is cheaper than 320 a month + ~280 a month until the deductible is hit. Of course this only applies to me. Not to here and my step-father who have very good health insurance even if she never goes to the doctor to use it (she also why I had bronchitis for three weeks almost before she'd let me see the doctor, and why I was sick pretty much from nov- to early Jan last year). Since there are 'free' clinics (she does not understand waiting lists) I should go to those. If there is a wait I should go to Parkland's ER since Parkland will not turn people away if they can't pay. In my mom's eyes I should be supporting myself by now or have found a husband (or wife she's opened up to in the last few years) to be paying for all of this by now and taking care of all of this, and given her at least one grandbaby.
But . . . if out-of-network is covered, it'd be like free-$50 depending per month, plus some deductibles can be really low (mine is $500, but since I am poor and have cost-sharing it's effectively more like $100). This all sounds really frustrating and awful and I am sorry your health is at the mercy of this. I can offer no practical solutions, so have a cat.
I've got a phone interview tomorrow with someone from the state about 'healthcare' so we'll see though I'm sure it'll be the "You aren't pregnant, you don't have kids, you don't have disability from the government so nope!" song and dance again. But we'll see then I'll take it from there.
