Medical insurance co-pay too high

amother

Goldenrod

Fri, Jun 23 2017, 10:04 am

I have United Healthcare Oxford medical insurance through my husband's employer. I'm not working so I can't get different insurance. He works at a school and that's the only insurance that they're providing, no other plans. I spoke to my insurance and told them that the co-pay is too high every time I take the kids to the doctor ($30 for EACH child each time). My husband is the only one working right now and it's too expensive. They told me that his employer has to switch plans, but that doesn't look like it's happening. Do any of you know what else I could do? could I negotiate the co-pay with my insurance? It's too high for us.

groovy1224

Fri, Jun 23 2017, 10:10 am

Co-pay is not something you can really negotiate with your insurance company.

I know this doesn't help you, but your situation is actually not that bad. Neither my DH or I get insurance from our respective employers, so we pay a very high premium and have high copays to boot. It stinks. And even people that do get insurance through their employers are often left high and dry with sub-par coverage. It really stinks.

However, depending on your state, you may be able to get medicaid (qualification is based on income, of course) as secondary insurance. This means you would not (again, depends on your state) have to cancel your primary insurance, and medicaid would kick in and cover those copays for you.

Something to look in to.

amother

Goldenrod

Fri, Jun 23 2017, 10:18 am

groovy1224 wrote:

Thanks for the info. I'll look into it.

amother

Black

Fri, Jun 23 2017, 10:54 am

I'm not sure that they are allowed to legally waive the copay.
When I used to have some sort of Medicaid and had a $5 copay my doctors office never asked me to pay it. Now that I have a $40 copay I've never had a doctors office that didn't make sure I paid it.

SixOfWands

Fri, Jun 23 2017, 10:59 am

amother wrote:

"Routinely" waiving copays is, at least according to Google, Esq., both a violation of the contract between the insurer and the doctor, and potentially a felony (fraud). But if you have a lot of visits in a short time, I'm guessing it would be fine to ask for some accommodation.

amother

Goldenrod

Fri, Jun 23 2017, 11:10 am

SixOfWands wrote:

Yea, I've had lots of sick visits with my kids to the doctor and many times I came with all of them so it came out $90 for one visit. I guess I could ask at the office, but I doubt they'll do anything. I have to check out medicaid.

amother

Puce

Fri, Jun 23 2017, 12:29 pm

First of all a doctor is not permitted to waive the copay. Second of in Brooklyn oxford freedom pays 52.33 a visit and oxford liberty pays 46.05 a visit so if the dr doesn't collect the copay he will be getting 22.33 and 16.05 a visit. For that he could gave skipped med school and be a cleaning lady.
.

seeker

Fri, Jun 23 2017, 1:28 pm

Do you pay a premium or does the job provide the health insurance for free?
My husband's employer offers family health insurance but you need to pay in (for the employee it's free.) I was told that if we declined the employer's health insurance for the kids then they could enroll in Child Health Plus. They have a small premium (depends on income level) and no copays (or small copay, depending on income level)

tichellady

Fri, Jun 23 2017, 1:34 pm

amother wrote:

I know for a fact that doctors will sometimes choose to waive or adjust the copay. Yes, the insurance companies don't officially allow it but it's not typically enforced or enforceable. You can ask the doctor to waive it, but be aware that this is his/her livelihood ( and pediatricans typically are not paid so well) so I would only ask if you are really unable to pay. Perhaps you can work out a payment plan for the copay, to pay half upfront and send in half a little later if that would be easier. Some patients in our practice do that.

amother

Goldenrod

Fri, Jun 23 2017, 1:38 pm

pesek zman wrote:

Are you Able to use health flexible spending accounting for the copays?

We haven't applied for flexible spending but there's an option at his job. Is it worth it?

amother

Wine

Fri, Jun 23 2017, 2:03 pm

AFAIK it is illegal for a doctor to waive a copay and I think you would be putting the doctor in a bad position by asking him to do so.

All children are eligible for Child Health Plus. The premium depends on income and family size and ranges from free to several hundred dollars. There are generally no copays.

The cost of medical insurance in extremely frustrating. I pay over $400/month just for myself (my employer deducts it pre-tax but does not cover any of the cost), and I still have a deductible that is several thousand dollars. Does your DH's employer pay the cost of the insurance premiums?

amother

Powderblue

Fri, Jun 23 2017, 2:47 pm

amother wrote:

No. All children are not eligible for child health plus. Children in NY are. Other states generally don't have such a thing. Some do, but many don't. You dont know where op lives. Where I live, we dont qualify for anything. Not even the childrens health program that you pay into.

gold21

Fri, Jun 23 2017, 2:55 pm

But whaddaya mean, the Affordable Care Act is, like, the saving grace of all mankind!

No, I'm kidding, but in all seriousness, if it helps you to know that many families are struggling with the same issues- the high deductibles, high copays, and poor coverage... You shouldn't feel that you're alone with this challenge. Good Luck.

amother

Yellow

Fri, Jun 23 2017, 3:00 pm

We pay $1,000 a month for the 2 of us (slightly subsidized through employer shock

) and copays are $50 a visit (except for PCP which is $30). It's so hard and really painful.

pesek zman

Fri, Jun 23 2017, 3:01 pm

amother wrote:

We haven't applied for flexible spending but there's an option at his job. Is it worth it?

Your husband may have be option of setting aside up to 5k pretax money, which can be a real savings. Do the math: figure out home much you spend out of pocket on assorted copays. When open enrollment comes around for your husbands employer (likely in the fall) definitely should be something to consider for 2018

amother

Yellow

Fri, Jun 23 2017, 3:05 pm

amother wrote:

We haven't applied for flexible spending but there's an option at his job. Is it worth it?

If you pay in $5,000 for the year, that money will be pretax and you'll save approximately (depending on your tax bracket) $1,400 in taxes.

tichellady

Fri, Jun 23 2017, 3:06 pm

Doctors are allowed to waive copays occasionally for financial hardship. This is the one exception and it needs to be used reasonably and the practice may ask the patient to send in documentation to prove that he/she is in a place of financial hardship. Many doctors feel a moral obligation to continue seeing patients even if they are not being paid. I wouldn't take advantage of this kindness, but if you need it, I think you can ask and see.

amother

Natural

Fri, Jun 23 2017, 3:41 pm

Definitely look into FSA
Also look into Aflac. It's additional insurance, really cheap, and they pay YOU when u go to the doctor. So it covers ur co-pays etc