Here is an email where a prospect requested information about the Vista health plan open access 1000 plan. They also wanted to know about Vista's network in Broward County. Here is our summation of their health insurance question.
Question: Regarding plan OAC15-1000 – Can you explain how deductibles work. For example, the annual deductible ($1,000, Hospital Services only). What is that mean? About the annual out-of-pocket limit. What is that mean? Can you explain the coinsurance? Is my primary doctor, Dr Barbarite in the network. Perhaps, you can direct me to a website with listings of networked physicians.
Answer: Yes that is correct, the $1,000 deductible is just that – a hospital deductible and applies only in the hospital. For instance, if you go to a freestanding facility, diagnostic center, ambulatory surgical center to have surgery, MRIs, CT Scans, etc performed you will only have the applicable copayment apply; you will not see your deductible. That's the same for the Emergency room as well – that is only a $100 copay.
However, if you do any of these or other services in a hospital then you will get a bill that will go towards your deductible. For instance if you were admitted into the hospital and had a $2000 total amount of medical services rendered then you would pay the first $1000 (your deductible in which you pay first before the insurance kicks in so to speak – and then Vista would pay 80% and you would pay 20% of the remainder of the bill – so in this case another $200).
Let's say the bill is $100,000; then you would pay the first $1000 (your deductible) and then 20% (that's your coinsurance) but to a maximum out of pocket of $1500 bringing your annual maximum total out of pocket including copayments and your deductible to $2500 – that is your worst case scenario. Vista would then cover everything else to no limited; lifetime maximum benefits are unlimited.
And I apologize if I am being redundant, but just to be clear, coinsurance is your responsibility of the bill. Often times you will see 80/20 – meaning the insurance carrier covers 80% and you pay 20% but to a limit. Whereas some carriers will have you pay 25% let's say but to no end..that is crazy. because if you had a million dollar bill then you're maximum exposure is quite substantial. Here you know that you pay 20% after your deductible to a maximum of $1500 out of your pocket.
Yes, Dr Robert Barbarite is in the network – I can say that off hand because people do ask for him specifically.