Basic Queries on Insurance

[chetanw]

Hi,

I am planning to invite my mother to the USA for 3 months to visit me. I had some basic doubts even after I had read a number of the postings here:

Let's assume that I purchase the Patriot America plan for IMG for a total coverage of $50000 with the 90/10 coinsurance option with a deductible of $500 for the complete 3 months of my mother's visit. In that case:

1. If my mother has the first incidence of high fever, and a doctor's visit is necessary and the charge for that visit are $100, then how much of that amount will I need to pay (considering the $500 deductible)?

2. What if I have to do a repeat checkup visit after another 10 days (so that is another $100 doctor's charge)?

3. Assume that the diagnosis is flu and she has to be hospitalized for 5 days with a cost of $5000, then how will the payment be done?

4. How does the IMG Company keep track of the expenses against the deductible i.e. how will they know that I've paid by $500 and they now need to start paying further expenses?

Thank you,
chetanw
Pennsylvania

[insubuy]

1 &2.
All $100. Insurance company will not pay anything until you completely satisfy your deductible once.

3. After the deductible, insurance company pays 90% for first $5,000. Therefore, you would pay $500 (10% of first $5,000) if you have already satisfied your deductible.

4. They keep track by the claims filed, either by you or by the provider. If you just pay cash don't let IMG know somehow, they don't have any way to know.

[nmg1974]

If you are paying the doctor completely from your pocket...so as to satisfy the deductable...do you need to inform the insurance company... ?

In other words...let us say my decuctable in 500$., I visit the doctor and pay 100$ (all from my pocket as it is part of decuctable)....do I need to inform the insurance company or file a claim still ? so that they can keep track ?
If the visit is for something that is not covered under insurance (say as it is pre existing), does it count towards the deductable ?

Also, do you know what is a doctor's fee on an average for a visit for say flu or checkup for some kind of a pain , say knee pain or joint pain.

Thanks,

[insubuy]

1. Yes, you (or doctor) still need to inform the insurance company. Otherwise, insurance company will not know that you have already satisfied your deductible. And if you get a bigger sickness in future, let's say $20,000 bill, they will still consider your deductible not satisfied and deduct that much money.

2. Only covered expenses are counted towards the deductible.

3. Dr.'s fee really varies based on the location, speciality and amount of work done in the office. I have myself seen personally anywhere from $75 to $350 for my own family's doctor visits. But it can really be anything.