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Edited on Tue Nov-16-04 12:42 AM by xray s
You also have to consider what the insurance business calls "reasonable and customary fees" and maximum out of pocket caps.
Initially, you pay 100% of your medical bill, up to the annual deductable. Then, you pay your out of pocket percentage of the total bill, IF the charge is "reasonable and customary". If it is NOT, you may be responsible for the difference between what the insurance company is willing to pay and the amount the doctor bills you for, not just the 10% or 20% mnetioned in your plan. If you are in a PPO, the doctor and insurance company have negotiated in advance what they will charge. In that case, you still run the risk your doctor may recommend a procedure not covered by your policy, which you will be 100% responsible for.
Now, your policy probably has an annual maximum out of pocket amount, like $2500 or $5000. That is the most you will pay in a year (unless the other issues I raised above kick in). The maximum usually is not actually a maximum, because they usually cap their lifetime benefit at $1,000,000, at which point you are on your own, until you are destitue and can qualify for Medicaid.
Or move to Canada...which I am seriously considering.
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