Question

In this state, each employees’ insurance plan is considered primary for him or her, which means Mrs. Gonzales’s HMO is her primary payer and the $25 copay from her last visit in now past due because she wanted this submitted to her husband’s insurance. The insurance company refused coverage because of a $1,000 yearly deductible, which has not yet been met. How will you handle this?

Answer 1

Many health plans don't pay benefits until your medical bills reach a specified amount, called a deductible. If you don't meet the minimum, your insurance won't pay toward expenses subject to the deductible. Nonetheless, you may get other benefits from the insurance even when you don't meet the minimum requirement.

A health insurance deductible is a specified amount or capped limit you must pay first before your insurance will begin paying your medical costs.

In this case Mrs. Gonzales has to pay the deductible is the only solution.

Now that you have paid $1000 towards your deductible, you have “met” your deductible. Your insurance company will then start paying for your health insurance expenses