please help… so confused – "calendar year deductible"
I started a new job at the end of July. The health insurance coverage started September 1st. When would my deductible start over? January? I need to do some physical therapy and I have to reach the deductible of $1,500 for co-insurance to kick in (I pay 20% after it’s met.)
The place I called said they checked with my insurance and through them, I’ll pay $175 for the initial exam, $200 per visit for the first 6 visits, and then $40 per visit.
It irks me that the self-pay price is $125 initial visit, $100 thereafter.
I’m so confused about what to do. It it pointless to meet the deductible if I have to start over in January? Should I just do the self-pay price? If I take the insurance pricing, would I pay 20% of the $40 visits after my deductible?
To further confuse things, I read the following info in my booklet:
Deductibles
• Calendar Year Deductible
Applies to all Eligible Expenses
Three‐month Deductible carryover applies
Calendar Year Deductible: The individual Deductible amount shown under “Deductibles” on your Schedule
of Coverage must be satisfied by each Participant under your coverage each Calendar Year. This Deductible,
unless otherwise indicated, will be applied to all categories of Eligible Expenses before benefits are available
under the Plan.
The following are exceptions to the Deductible(s) described above.
Your Schedule of Coverage indicates “Three-Month Deductible carryover applies.” This means that any
Eligible Expenses incurred during the last three months of a Calendar Year and applied toward satisfaction of
the Calendar Year Deductible for that Calendar Year may be applied toward satisfaction of that Deductible for
the following Calendar Year.
Does this mean if I wait until October, the amounts I pay towards my deductible would carry over into the next calendar year? I’m not in extreme pain – I’m thinking I could wait until October to address my issues.
Any help is greatly appreciated! I have BCBS of TX, btw.
