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Family Deductable vs. Indivual for Payment




My insurance company requires that each person either meets their $200 deductable or if our family has met the family deductable of $400, that can be used instead. When I went to the doctor they would only look at my deductable and not my family deductable. While neither have been met, one has been met by $60, and the family by $293. Can they really charge me based on my deductable alone, or do they have to go look at the family one as well.
The insurance person at my doctor refuses to look at the family deductable. I am going back tomorrow and we can not be seen without payment. It is not fair to make us pay even when we met the deductable?

In: Deductible Asked By: [2 Grey Star Level]
Answer #1

First, I need something clarified. You state that neither deductibles have been met. You then state that your deductible “has been met by $60, and the family by $293″. I assume this means that you’ve had $60 applied to your deductible and $293 applied to your family’s deductible. Can you confirm this?

It is hard to give an answer not knowing your policy. If the doctor’s office is doing their job correctly, they are verifying coverage with your insurance company. They should also be verifying your responsibility including your deductible.

Therefore, yes, they can collect for the deductible if your insurance company is stating your deductible has not been met.

There are times that other doctor bills haven’t been applied to your deductible at the time the insurance was verified. In this case, the doctor’s office would get an EOB stating what they should have collected and you would receive a refund for the payment you made.

Hope this helps.

Answers Answered By: Brooks [9 Grey Star Level]
Answer #2

Okay sorry I have not met either deductable, but based on the insurance policy we are required to meet that and then have the rest billed. When I talked to the docs office yesterday I told her I had the EOB’s to prove the family deductable but she said that she will not look at the family deductable she only cares about what I personally have met.

Answers Answered By: swimchick713 [2 Grey Star Level]

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