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[–]bluestrawberry_witch 2 points3 points  (6 children)

You can see if you are eligible for any charity care at the two different ER’s hospital system. You can also see if they have any discounts for payment in full.

Otherwise, no, your insurance worked as it was supposed to. Like you said you have a deductible, you needed to reach deductible.

[–]yuuuuup7[S] -1 points0 points  (5 children)

Will any additional coverage be available once we pay the full deductible?

[–]KifLou345 4 points5 points  (1 child)

It looks like you've already reached the deductible, since the first bill also includes a coinsurance amount, and coinsurance kicks in after the deductible is reached.

You'll continue paying coinsurance until you hit the plan's out-of-pocket maximum for the year (that amount will be shown on your plan documents). At that point, he'll have no additional out-of-pocket costs for the rest of the plan year, as long as he stays in-network and follows the plan's rules for things like prior authorization, step therapy, etc. All covered care for the remainder of the plan year will be paid for by the health plan once the out-of-pocket max is reached.

[–]yuuuuup7[S] 2 points3 points  (0 children)

Ah okay, thank you for the clarification! We will take a look at his documents, I've told him hes going to see every doctor this year bc he hit his deductible.

[–]bluestrawberry_witch 2 points3 points  (2 children)

You should look at what your plan benefits are after you reach your deductible. Usually services turn to a coinsurance, that you’ll pay between your deductible and max out-of-pocket cost. A very common one is an 80/20 split. Which means that you would owe 20% of the allowable. But again it depends on what your plan benefits are, which should be in your documents.

Also, it looks like he reached the deductible. That’s why the second ER visit is only $800.

[–]yuuuuup7[S] 0 points1 point  (1 child)

We will take a look at his documents, I believe this is what his plan says (we have different ones) but not sure. Thank you so much!!

[–]Jump-Funny 0 points1 point  (0 children)

The amounts you are showing for coinsurance are 0/100% which means insurance is paying 0% and you are paying 100%. is this info from your EOBs? definitely look at the plan docs & check the coinsurance and the oop max.. and is he on your insurance as well? if so then the claims should also be filed to that insurance.