I have insurance thru blue cross blue shield. I recently went to an eye doctor to have eyes check. well I was told I have cataracts. my insurance deductible is 3000.00. I just started the insurance in January 2015. my deductible has not been met. its still 3000.00. my credit is not the best due to divorce of course. I live pay check to paycheck. I need this surgery because like every red blooded American I need my job. I wear glasses but I still can not see well. I have my drivers license test coming up and in my job I need my license. I can not see well enough to pass the test. I’m not considered legally blind because of the cataracts in both eyes. But if I don’t have the surgery I can go blind with in a year. and I will loose my job. I am a service technician and I need my eyes. I’m 52 yrs. old, a little late in life to start a new profession. I applied to 4 different health care credits and all turned me down for lack of credit or bad credit…only one on bad credit. since the divorce I pay cash for everything. I use a prepaid debit card with which my check from my job is direct deposited in. so much easier than a bank. my girl friend has called over 15 eye surgeons and none so far do not do in house financing. I have been able to put back approximately 500.00. but that’s all so far. how do I get my deductible paid or get a loan so I can get my eyes fixed so I can keep a job and support my family. I can pay back at least 300.00 a month on the balance of the deductible. but can’t find anyone to help. what do I do. I have tried everything. I don’t want it for free I want to pay my way in life like I always have. I just want and desperately need financing. where do people go in these situations. I sure i am not the only one. I have less than a month to do this. Please help. thank you
Do they do consumer loans for human health care? I know people with less than perfect credit who have financed veterinary care through a Care-Credit loan.
ETA: here it is: About Us | CareCredit
This question may be better suited for another one of our subforums but I will give it a shot. There are several possible answers but I will only give the ones relevant to the information you gave.
In your case, I think your mistake is trying to do things backwards.
You have insurance and the specific details of your deductible are largely hidden from your doctors as long as they take the insurance in the first place. You don’t have to tell them anything in advance about payment other than what plan you have and ask whether they take it (almost everyone takes Blue Cross Blue Shield). You can have the necessary procedure(s), let them submit your insurance claim and only later will get get a bill showing the portion you owe.
At that point, you have the advantage and can pay on whatever schedule you can afford to. The great majority of doctors’ offices offer payment plans once you owe them money. They may not tell you that in advance but it is extremely common for patients to request and receive one even including discounts if you can pay it back early. Lots of patients never pay there deductible at all and they are usually more than happy to work with someone that will pay it back over time rather than never. You say you already have a bad credit score so there is little downside in your case (paying back a deductible as agreed will not hurt or help your credit score but going into collections for it will but that generally takes a long time and lots of missed payments).
I think your problem is that you are trying to be too upfront and honest in a way that is going to hurt you and really isn’t expected in the first place. Of course doctors want their money as soon as possible but you don’t have any obligation to advertise the fact that you may not be able to meet your deductible beforehand. Let’s put it this way, if you had appendicitis, do you think doctors would just refuse to treat you unless you flashed a wad of $100 bills right there in the emergency room? Your case doesn’t sound much less serious. They will get lots of money from the insurance company and then I am sure you will pay back your deductible as well as soon as possible. That is a lot better than many patients do.
You could also talk to the case manager at the hospital where you plan to have this done. They deal with this kind of thing all the time.
I agree with the other posters. I would schedule the surgery ASAP. After it’s done, you’ll get a bill in the mail for 3k. If you can afford to pay them 300 a month, I’d call (after you get the bill) and tell them you can pay 100 a month. Use the other 200 to build up more of an emergency fund.
Just to clarify, if you are under the impression that your insurance plan is out of the picture and you have to pay everything upfront and out of pocket before you meet your deductible, that isn’t true. Your insurance plan is still in effect and determines how much the doctor gets paid for specific services or procedures. Even if you haven’t met your deductible, the claim still gets processed by your insurance company, they pay their negotiated rates and then forward on the portion not met by your deductible to your doctors office after that is all settled.
In my experience, the time between a procedure and a bill arriving in your mailbox can be as long as three months. The doctor’s office doesn’t even generally know about the specifics of your plan, how much your deductible is or how much you have remaining on it until after they submit your claims and wait for the settlement from your insurance company. It isn’t standard practice to give your doctors office or hospital anything more than your basic insurance plan information before they treat you. You can worry about how to pay the deductible or how to negotiate it into something you can manage after you get the bill.
Are you sure your insurance even covers vision problems? Usually vision is separate from medical.
I know that American insurance plans are hopelessly confusing but there is big difference between medical eye problems and vision problems as covered under dedicated Vision plans. Vision plans are indeed separate and cover things like eye exams, eyeglass prescriptions and contacts. However, there is a whole host of other eye related disorders that are covered under medical plans. Those include things ranging from glaucoma, detached retinas, scratched corneas and cataracts like the OP has.
I don’t blame him or anyone else for being confused about the whole insurance process because it is still a tangled web of many different non-intuitive and sometimes conflicting standards but it really isn’t that hard to navigate if you just let someone knowledgeable tell you what to do in a given situation.
Shagnasty - former consultant to the benefits industry.
Since the OP is looking for advice, let’s move this to IMHO.
Colibri
General Questions Moderator
The industry standard for timely filing is between 6-12 months, add 60-90 days for the insurance company to process the claim, and it could easily be over a year before the OP even get’s the bill. Or every could be on top of he ball and it’ll take all of 6 weeks. Either way just get the surgery done now and figure out how to pay for it later.
wow thank you all so much. its been a long time since I had been insured and you all are correct…as they say take me back to the good ole days…thank you
Good posts, Shagnasty.
Cataract removal is covered by regular health insurance.
By all means stay on top of the charges your procedure generates! Last year I had a cardiac catheterization and stent placement. The hospital where the stress test was done wanted to send me by ambulance to another hospital around ten miles away, where the procedure would be done. I objected to the ambulance ride, saying I could drive myself.
They convinced me not to drive, but I made some calls. The ambulance they wanted to use was sitting there waiting for me. My insurance would cover just a small fraction of the cost. However, if I used an ambulance from my home town (an hour drive away) my insurance would cover the entire fee.
So, I waited about 90 minutes and had a free ride.
This has not been my experience at all. Go to see a doc and they will pull your insurance up and see where you are on your deductible. Just took one of the raindrops in for a sports injury and they advised us that since our deductible hadn’t yet been met to plan on paying X amount up front. YMMV.
Filing is usually much faster than that, actually. I’ve rarely had any kind of claim take more than 2-3 weeks to show up on the insurer’s page, then it’s paid within a few weeks as well.
Many medical facilities will demand their share right up front. I would definitely encourage the OP to contact the provider and work on setting up some kind of payment plan.
The OP said he already did that and it didn’t work. I realize that there are about a bazillion different combinations of medical plans, doctors offices and jurisdictions in the U.S. but what you are advising isn’t standard practice.
What you are saying applies to people without any insurance but it isn’t really applicable to people that have a reputable but high-deductible insurance plan like the OP (I have one too and I have been through this sort of thing several times personally with several different doctors and hospitals).
As noted above:
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You still have insurance even if you haven’t met your deductible and that determines the rates for specific procedures.
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All claims still go through your insurance company even if you haven’t met your deductible yet. Doctors and hospitals usually aren’t even allowed to ask for upfront payment except for the token copays if you are covered under a plan that they accept.
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The doctors office or hospital likely won’t know the specifics your plan, your deductible or how much you have left on it until they submit a claim because there are so many different variations and billing staff can’t see detailed information about about the current state of an individual patient’s insurance other than what the active plan is. They usually won’t even know how much they will being getting paid for a specific patient/procedure until the settlement is finalized well after the treatment is long done.
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A patient has no special responsibility to divulge information that wasn’t asked before they accept treatment. Doctors themselves are notoriously ignorant about how much anything will cost a patient because they truly can’t know themselves until the claims are processed even if they were interested in those types of details.
I agree that it is still a huge and confusing mess but that is the true state of medical insurance in the U.S. today. I have dealt with it from multiple angles. However, the intent of high-deductible plans wasn’t ever for people to refuse necessary treatments until they can save up enough money to meet their deductible. It is well understood that many people can’t pay right away and the vast majority of doctors and hospitals are more than happy to work something out with you after you get your bill.
As an odd coincidence, the large practice group that my primary care doctor falls under sent me a handy little article going over this just today. I already knew it but apparently enough people were confused about deductibles and copays that they sent out a mass education supplement to explain it to their patients.
Another handy tip is just to know is that the medical industry business model is closer to a pawn shop than it is to a supermarket. I got a bill for over $1700 after I had to make an unfortunate hospital visit about 8 years ago and all the various charges not covered by my insurance were processed. I didn’t have the money at the time so I called the hospital billing department.
The call went something like this:
Billing specialist: Hello
Me: Hi, I just got a bill for services but I don’t have that much money to to pay right now.
Billing specialist: Sorry about that. We hear that all the time? What do you want to do?
Me: I will pay it if you can set me up on a payment plan.
Billing specialist: We might be able to do that. What were you thinking?
Me: About $200 a month until it is paid.
Billing specialist: That might be OK but let me ask you, how much money do you have now to pay the bill?
Me: About $800.
Billing specialist: That’s not too far off. I can’t let you go for that but tell me if you think you can come up with an even $1000 within 30 days and send that in. We could call it even if you can do that.
Me: That sounds like the best news I have heard all day. You will have it (and they did).
Billing specialist: Thanks for calling us.
That was the best discount I ever got but I have gotten other rather generous ones as well. Deductible payments are still among the few things including cars and real estate that you can still negotiate on without anyone blinking an eye. They always want a decent amount of money right away versus small sums that dribble in over time and especially not no money.