This blog started out as an ankle sprain blog in honor of Janise’s recent bad luck. It was going to poke fun of the fact that she has a pretty bad ankle sprain; however, it has turned into a more serious situation, so it isn’t that funny anymore. Consequently this is turning into a blog about what to do if you sustain and injury and have a large deductible.
The perils of a large deductible
Having a big insurance deductible is a really stressful option, but in this day and age, it’s one choice that many of us have to make. Think about it….it’s really a “money swap” when you gamble with a lower monthly insurance premium and then lose due to a serious injury or illness. You “save money” on the front end only to really “take it in the shorts” when that $6000 is due all at once. Maybe that’s really why it is called a catastrophic policy. You really don’t have to lose if you make informed decisions on how you spend your deductible dollar in non-emergent situations.
The night of the ankle sprain
Since Janise is an ankle sprain veteran, she knew that even though this wasn’t like any other ankle sprain she had had before, it was still not life threatening. Therefore, a trip to the emergency room wouldn’t be necessary. She has a $6000 deductible like many people, so she applied an ACE wrap, iced and elevated it through the night, as you would do with a typical ankle sprain. The morning after the incident, Marla evaluated her ankle and decided that it was likely that there was some type of fracture. To determine the extent of the fracture, she needed an x-ray. Here is where using your insurance becomes a gamble.
If you are willing to drive to the front range and cash pay an x-ray, you can get one done for $65. The risk here is that if, for some reason, the case becomes surgical, you have paid for something that will not be applied to your deductible. Janise took this gamble and it was determined that she did have a fracture. From there she followed up with an orthopedist.
Now is when you use your insurance
The orthopedist determined that this was a much more complex case than a typical ankle fracture. Taking the gamble of a cash pay x-ray did not pay off here since she paid for a service that will not be applied to her deductible. This case required additional x-rays, an MRI, and has since become a surgical case. At this point, since Janise will need surgery, it made sense to go ahead and start tapping into her deductible for the additional x-rays and MRI. The hospital x-rays will cost more when they are billed to insurance, but now she knows that she will be paying her deductible anyway so it is best to just start chipping away at it.
What to do since her deductible is met
Since her deductible is going to be met for the year and it is only March, for the rest of the year it will make sense to go ahead and use her insurance for any other medical care that she might need. At this point she will only be subject to a co-insurance (which will be 20%) of the billed amount until her out of pocket max is met. Once that magic number is met, she will no longer have to pay for any services.
What if this wasn’t surgical?
Unfortunately, Janise has a surgical ankle. However, if it wouldn’t have been surgical, it would have benefitted her utilizing the cash-pay x-ray. She would have only had a cash-pay office visit with the orthopedist and a $65 x-ray. If she would have used her insurance in this case, it would have cost her closer to $500.
At Momentum, we offer very affordable cash-pay rates and a variety of membership and payment plans that can help you get high quality care at a reasonable rate. If you have any questions about our cash-pay rates please call us to discuss at 970-522-1969.
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