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Originally Posted by jnieman
Yes we have the family plan for the two of us. If you check the policy BC/BS Federal requires a 15% co-pay for tests like MRI, Xray, bloodwork, CAT Scan, out patient procedures (15% of the allowed amount), etc. These days many, many surgeries are outpatient that used to be in-patient and they only pay the allowed amount on these and the doctors most times will send you a bill for the rest which includes the anesthesia, tests and doctor's bills. Those have been putting me in the poor house for the last five years. Recently I spent 8 hours in the emergency room for food poisoning. My out of pocket for that was $777. It was the difference between the hospital bill and what the insurance paid. When I get medicare to go with my BC/BS Federal I am praying all that goes away. Not sure where these fall in the catastropic part because they don't really say in that article. I have to assume if they were considered catastrophic BC/BS would have stopped charging me for them long ago. When I did my taxes this year I had over $20,000 in medical. Some of that was premiums but the rest was not it was what I mentioned above as well as doctor co-pays. Might be worth a call to BC/BS.
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If you use the Blue Cross preferred providers for medical care, the provider cannot charge you more than the amount allowed by Blue Cross. The only way a doctor can charge you more than the allowed amount is if they are not a preferred provider, but almost all bona fide providers in the area are preferred providers. I have never had a problem finding a good preferred provider for Blue Cross. And, when your out of pocket costs, such as copays and coinsurance, exceed the catastrophic annual limit, Blue Cross will cover everything else at 100 percent. That is the way the insurance plan works. In general, Medicare is not going to cover things that Blue Cross doesn't. It will only reduce your copays and coinsurance payments, but you need to weigh that benefit against the cost of the Medicare premiums.