Cost of a doctor visit

[Joanne]

I am trying to decide on a health insurance plan. In order to compare different type of plans, I would like to get an idea on how much each office visit to the doctor would cost. My hubby didn't have to make any decision when he came last year. He was automatically enrolled in the school's program, never had a chance to visit a doctor (which is good), so he has no idea about this issue. I am getting anxious as the clock ticks away.

 

Don't know where is the best place to post this message. So I try it here. Thanks a lot for your input.

[warpedbored]

Depends greatly on the plan. Some HMOs have plans where with a co-pay you only pay 20 dollars or so. These plans don't always have great coverage for catstrophic illness and HMO doctors aren't always all that great. You have less choices with HMOs. Other plans pay 80% up to a capped amount then pay 100% over that. these plans are generally better for catastrophic illnesses. They also give you more leeway in choosing your physician. Can your husband get you coverage through his school? Health insurance is very expensive. I pay about $330.00 a month for just Bing and I and thats after my company picks up part of the tab.

[Randy W]

A doctor's visit is typically around $60-$100. A preferred provider agreement with your insurance company will get that down a little, and you would usually just pay the co-pay (say, $20).

 

This is different than a HMO, because the PPO's do not work directly for the insurance company, and you usually have a much bigger choice of physicians.

[Joanne]

I am trying to steer away from HMO. Am considering seriously for a high deductible plan. That's why I am interested in knowing how much a full charge for a doctor visit would be. Thanks for your info, Carl and Randy!

[Joanne]

Depends greatly on the plan.  Some HMOs have plans where with a co-pay you only pay 20 dollars or so.  These plans don't always have great coverage for catstrophic illness and HMO doctors aren't always all that great.  You have less choices with HMOs.  Other plans pay 80% up to a capped amount then pay 100% over that.  these plans are generally better for catastrophic illnesses. They also give you more leeway in choosing your physician.  Can your husband get you coverage through his school?  Health insurance is very expensive.  I pay about $330.00 a month for just Bing and I and thats after my company picks up part of the tab.

189567[/snapback]

The school's plan is comprehensive. The rate is OK for the student but too expensive for family members. (Well, if we had ten kids, we would have a good deal.)

[david_dawei]

I just went through this exercise of looking for 'major medical' or 'catastropic insurance'... Often various 'riders' can be added to this base policy to add a little more coverage for this or that...

 

Be aware that some plans being sold now are only 'discount plans', which you can get very cheap ($130/month), so that any doctor visit is discounted by 20% or more.

 

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National average for doctor visit is : $60

National average for ER visit is: $380

National average fro Hospital one-day stay is: $3,000

 

You'd have to get more specific, down to the state or city is best.

 

I've had doctor rates in the Northeast to $120/visit... not sure if that goes down if the doctor knew one was self-pay !!

[Joanne]

I just went through this exercise of looking for 'major medical' or 'catastropic insurance'...    Often various 'riders' can be added to this base policy to add a little more coverage for this or that...

 

Be aware that some plans being sold now are only 'discount plans', which you can get very cheap ($130/month), so that any doctor visit is discounted by 20% or more.

 

---

 

National average for doctor visit is : $60

National average for ER visit is:  $380

National average fro Hospital one-day stay is: $3,000

 

You'd have to get more specific, down to the state or city is best.

 

I've had doctor rates in the Northeast to $120/visit... not sure if that goes down if the doctor knew one was self-pay !!

189578[/snapback]

Thanks, David. I will start searching from those two key phrases. We are in philadelphia.

 

Another thing I want to try is to go to a nearby clinic or doctor's office, see what kind of plan they accept. Sounds like a good idea?

[jim_julian]

Joanne this is a really hard area in which to get an accurate estimate. Doctors, emergency rooms, and hospitals often bill for very high fees and then your health insurance settles for less. How they would deal with an individual paying directly I don't know but I suspect you may pay more than an insurance company would.

[jemmyell]

Hi Joanne,

 

Be careful about the HMO / PPO decision. Many factors apply. I don't think that the 80 / 20 plans are that great for catastrophic illness since even paying 20% will be financially devastating given current medical costs. They are better for average treatments, you usually get more time with a better doctor.

 

If you get an HMO, quality matters GREATLY! If it is Kaiser I will not personally consider it. They tried to kill my sister once, me twice and left my broken neck treated with muscle relaxants. They did not even xray my neck after a pretty major fall trauma.

 

If the HMO is just an artifice of the insurance company and the providers are independent offices and clinics, the situation is better. If the HMO is like Kaiser then you will probably get very poor medical treatment. These organizations hire doctors that should not be allowed to practice many times.

 

WE had just switched to an HMO plan for financial reasons when my wife became ill with cancer. This is the only way I avoided bankruptcy. The service from the Primary Care doctor was horrible (she told my wife, oh you're sick you will die!) but I was able to get her oncologist to provide many other services also.

 

If you have a PPO plan and the only provider office you can use treats mostly HMO patients, then you will probably not get any benefit and just pay extra. When I had a PPO with Harriman-Jones here they would not provide ANY different service levels at all but were very happy to get the extra 20%

 

The real key to medical problems these days is to study and know as much as you can. With small children the pediatrician will be the Primary Card Doctor and they are better than most since all the bad pediatric doctors have been sued into oblivion already. Just make sure that the kids get the best care you can. watch them closely for ear infections and fevers. if they do get a fever, you will be the first line of defense so you need to know some basics. NEVER give a young child aspirin, use childrens flavored tylenol for fevers, and if a child runs a VERY high fever and becomes drowsy, then COOL them down asap with a cool / cold sitz bath even before calling 911 if you are alone at home. Read all the first aid / home care books for the kids you can, they are the real concern for a young family IMHO. I give this advice as a parent who watched his daughter go into convulsions because my wife and her sister did everything wrong with a high fever in a very young (2 years old) child.

 

For yourself and your husband I think a HMO with you aggressively following up and questioning all decisions, medicines and protocols is probably best.

 

Just my opinion, but based on real experience...

 

-James

[david_dawei]

The 'discount plans' I mention settle a lower rate for you... CAREington is one of the most popular.

 

Here's a link for Philly healthcare.. .shows you the major players for managed care (HMO) and PPOs... you can try to find some of these websites to see what kind of plans they offer closer to what you want.

 

http://www.temple.edu/hastu/pages/HC Phila/PHILA.pdf

 

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Most doctor's offices will simply say they accept most insurances.. you'll have to give them a name (or a few) to see if they accept it.

Edited February 9, 2006 by DavidZixuan (see edit history)

[tonado]

Cost of my wife's dental visits is costing me more money than her doctor visits. Most dental insurance will cover up to $1000 to $2000 per year.

[david_dawei]

Hi Joanne,

 

Be careful about the HMO / PPO decision.  Many factors apply.  I don't think that the 80 / 20 plans are that great for catastrophic illness since even paying 20% will be financially devastating given current medical costs.  They are better for average treatments, you usually get more time with a better doctor.

189588[/snapback]

good point.. The 80/20 plans can have a deductible and/or contribute limit... so, once you meet the limit/cap, they take over 100% is best !

 

deductibles- applied first, before the company will pay anything

Co-pay - the amount you'll pay after deductible is meet, usually a percentage

Contribution limits - The 'cap' at which you pay up to, but not over.

 

There could be a plan where a 50/50 plan is better if the contribution 'cap' is lower ...but they often want you to get the 80/20 since it will be a little higher price (since they are covering more), but you often are paying 20% on every incident since the contribution limit could be a little higher!

 

 

Study it all thoroughly and ask questions ...

[jemmyell]

Hello,

 

I just re-read my post and I know it appears negative, so just take the advice with a grain of salt. My wife's illness cost the insurance company somewhere between 4 and 8 million dollars in my estimate. She had three major surgeries, MANY hospitalizations, specialized chemotherapy, etc. I would NEVER have been able to care for my children without the HMO plan. No money left....

 

It has been difficult anyways.

 

Sorry if I appear too opinionated on this, but I have been through a LOT and I am still basically my own Primary Care Doctor. The current ones are so badly squeezed you really need to be your own best friend in this. I argued with my current doctor for 6 months about a mole on my arm. After my wife died, I had myself audited for ANYTHING that might place me (and therefore my kids) at more risk. My doctor FINALLY agreed to have the mole removed just to humor me. It was a VERY rare pre-cancerous light sensitive thing, so he apologized profusely.

 

Read, study, question.

 

-James

[Joanne]

Be careful about the HMO / PPO decision.  Many factors apply.  I don't think that the 80 / 20 plans are that great for catastrophic illness since even paying 20% will be financially devastating given current medical costs.  They are better for average treatments, you usually get more time with a better doctor.

 

189588[/snapback]

Thank you very much, James. Those are very sound advices. You are right, the kid is the most important.

 

I agree 80/20 plans would probably not going to work for us. There has to be a maximum out-of-pocket amount. I didn't like HMO also because of previous bad experience. Some years ago, my hubby had a digestion problem. The doctor started a full examination from head to toe and found a mole on his back, so dug that up to examine. The doctor had completely forgotten what my hubby went to him for. Later, doctor called him want to get more samples from him. Hubby said no thanks, then took a few years learning how to take care of his own stomach.

 

My parents-in-law are using a HMO. It seems to me, most of the medical treatment they receive are not covered by their insurance plan.

 

This is a difficult decision for us. For the past few years, the medical expense we had in China wass so low, I didn't bother to get reimbursed for my bills. Now it is a different story.

[warpedbored]

I chose an 80/20 plan with a cap of $4500.00. After that the insurance pays 100%. At our age catastrohic illness is more likely and I wanted something that would take care of that risk. My choices were somewhat limited though since it is through my company. If I were to buy private health insurance it would cost me at least twice what I am paying now.