AVMED and Deductable ?

[Davis B]

Hi all,

I am just got signed up with ADVMED and like many of you, i don't trust what these insurance companies (or their reps) say. I'd rather get some feedback from experienced agents before i listen to the REP who's only been there 6 mths. I even called an in house agent and played dumb to see if i could get more info.

AVMED has some pretty good PPO rates...but their deductables are high. I called the Rep at AVMED and was told that the higher deductibles mean little as "avmed" gets a management rate (what-ever that means) and they get contracted rates, preferred rates, etc with the Hospitals (at lease that's what thye say).

...So if i have a client with a high deductbible...they want me to believe that ....they get a good deal for their clients because they get the contract rate plans? (i guess what the REP is/was Trying to say is that "AVMED" clients get contract rates that are lower and to reach your 10 deductible, your have a serious injury, etc).

Anyone have a client that went through a hospital stay using AVMED as their carrier and found favorable "contract rates" (or didn't get robbed) for their deductible (for a simple operation, etc)?

thansk in advance.

 

[moonlightandmargaritas]

Anyone have a client that went through a hospital stay using AVMED as their carrier and found favorable "contract rates" (or didn't get robbed) for their deductible (for a simple operation, etc)?

Don't see how it could matter.

If you've got a $2,500 deductible, whether the "repriced" bill is $2,600, $26,000 or $260,000 - the insured is responsible for the first $2,500.

 

[Davis B]

Don't see how it could matter.

If you've got a $2,500 deductible, whether the "repriced" bill is $2,600, $26,000 or $260,000 - the insured is responsible for the first $2,500.

Thanks Moon....so what you are saying is the line about "contract rates with hospitals" is BS.

If the bill is $65000...then a deductible of 10k would make the bill to the insurance companies 55k....correct?

 

[moonlightandmargaritas]

Thanks Moon....so what you are saying is the line about "contract rates with hospitals" is BS.

If the bill is $65000...then a deductible of 10k would make the bill to the insurance companies 55k....correct?

Yup, looks like you've got it right to me.

 

[Norwayguy]

Thanks Moon....so what you are saying is the line about "contract rates with hospitals" is BS.

If the bill is $65000...then a deductible of 10k would make the bill to the insurance companies 55k....correct?

Yes thier contracted rates may make the 65k become say 35k but you still pay the first 10k.

I think what the rep was trying to get you thinking is the insurance helps even before you hit the deductible because you 1k bill might be reproved to say 800 but you still pay 100% of that.

 

[Davis B]

Yes thier contracted rates may make the 65k become say 35k but you still pay the first 10k.

I think what the rep was trying to get you thinking is the insurance helps even before you hit the deductible because you 1k bill might be reproved to say 800 but you still pay 100% of that.

Its actually a slight of hand trick. You pay 10k...and the insurance company gets to negotiate down their obligations....they want you to "think" its a percentage....but its obvious that you are stuck paing 10k.

Unless you can figure a way to negotiate with the Hospital themselves?

 

[GreenSky]

Its actually a slight of hand trick. You pay 10k...and the insurance company gets to negotiate down their obligations....Unless you can figure a way to negotiate with the Hospital themselves?

So if you have a $10K deductible on a $35K bill it's different than if the bill is $65K?

You might want to rethink what you understand.

Rick

 

[Davis B]

So how bout this?

The bill at the Hospital is 15k...and you are stuck paying the first 10k....IS THAT RIGHT?

 

[DS4]

PPO plans re-price a claim first, then, the terms of the plan apply.
I have a 2500 deductible. I just had laser eye surgery. The billed amt was $3450. Allowed amt was $951.57. $951.57 was applied towards my deductible. Lousy insurance paid nothing!!
Bastards.

 

[Yagents]

First, a small insurance company is not going to have better contracted rates than the big boys.

Client pays the discounted rates until they hit the deductible.

Just saw my clients hospital bill today for like 3 day stay in Phx with Goldenrule /UHC. Initial amount was $30k, reduced down to 4600. UHC typically has the best discounts. Here it is:
2nd number is the dicounted rate.

HOSP-OTHER $4,786.85 $670.17
HOSP-OTHER $30,446.30 $4,596.91