Depending on your regular salary -Single is between $1057 and $1293 per year (between $44.08 and $53.88 per check) and family is between $2,856 and $3491.52 per year (between $119.03 and $145.48 per check).
If you waive insurance at the beginning of the year you do not pay these "co-insurance" amounts and get $500 or $1,000 in June. If 12 or more members from the Teacher Unit Waive insurance then these amounts are increased by $1,000 and $2,000.
There are a few reasons to have to pay out of pocket for medical services. The main reasons are as follows:
- The service is not covered.
If the service is not covered, then you are on the hook for it. It is best to prevent these types of problems by knowing your benefits, being familiar with the certificate of insurance that is available through the MMO website, and getting prior approval for services when it is required. If you get a hearing test because you believe you are losing hearing, most likely, it will not be covered. If you get a hearing test as a way of diagnosing some other illness it may. Know your benefits before you use them.
- The service was not coded properly.
Often the problem is not the way a claim was processed by the insurance company, but the way it was coded by the provider. Most often you can ask your provider to resubmit the claim with a more appropriate code and it will be covered. For instance, cholesterol lab work is not covered if it is coded as “routine,” yet if it is resubmitted with a diagnostic code that included hypertension it probably will be covered.
- No claim was submitted to insurance.
If MMO did not get paperwork, they will obviously not pay anything. Call the provider and see what they did. If they are not helpful in fixing the problem, then perhaps you should not go there again.
My medical bill was sent to collections
Sometimes people don’t realize they have to pay a medical bill and it eventually ends up being sent to a collections agency. If you truly owe the money then you should pay it before it continues to mess up your credit rating. If you believe you do not owe the money, then don’t pay anything, but call the collection agency and tell them you will be working with your union to get the bill settled. This should buy some time. Call us as soon as possible so we can help to figure it out.