Went from no medical cost to a ton - want to make sure I have the best plan

[ebbnflow]

I don't know much about the healthcare end but everyone at my job complains that my job's healthcare plans aren't great. This year I started seeing a mental health specialist weekly, another one every 1-2 months, and I spend about $50 on prescription drugs about every other month. These plan to continue indefinitely.

I've also started the process for bariatric surgery and have a ton of doc visits scheduled early next year (learned the hard way the.. $500 bill counting towards my deductible that will reset in a month lol) So I'd like to make sure I pick the best plan for this upcoming year. I think the EPO plan is still probably the best option but I'm not 100% sure of how some of these things work. Some co-pays are lower on PPO. So if I continue my weekly mental health that's at least $260 savings for the year. but that alone is not worth it for the difference in premium. How do I know which plan will ultimately be cheaper for the surgery

Choice


Choice Plus



In Network
Out of Network

In Network
Out of Network

Cost per pay prd.
$56.23
N/A

$112.19
N/A

Plan Type
EPO
N/A

PPO
PPO

Office Visit for Primary Doctor
$25
N/A

$20
40% co-insurance

Office Visit for Specialist
$40
N/A

$40
40% co-insurance

Coinsurance
$0
N/A

15%
[Blank]

Annual Deductible
$1,500 Individual/$3,000 Family
N/A

$600 Indivdual/$1200 Family
$1000 Individual/$3000 Family

Annual Out of Pocket Limit
$3,000 Individual/$6,000 Family
N/A

$3,000 Individual/$6,000 Family
$7,000 Individual/Family $14,000

Out of Country Coverage
Yes
N/A

Yes
N/A

Periodic Health Exam Annual
100%
40% Co-insurance

100%
40% Co-insurance

Generic Prescription Drugs
$10
N/A

$10
See SPD

Brand Prescription Drugs
$35
N/A

$35
See SPD

Nonprefered Brand Prescription Drugs
$50
N/A

$50
See SPD

Mail Order for Prescription Drugs
Tier 1 $20, Tier 2 $70, Tier 3 $100
N/A

Tier 1 Mail Order $20 Tier 2 $70 Tier 3 $100
[Blank]

Emergency Room
$300
N/A

$150
$150

Outpatient Lab/X-Ray
Subject to Deductible
N/A

15%
40% Co-insurance

Outpatient Surgery
Subject to Deductible
N/A

15%
40% Co-insurance

Hospitalization
Subject to Deductible
N/A

15%
40% Co-insurance

Mental Health Coverage - Outpatient Services
$25 Copay
N/A

$20 co-pay
40% coinsurance

Substance Abuse Coverage - Outpatient Services
$25 Copay
N/A

$20 co-pay
40% coinsurance

Out of Network Authorization Required
N/A
N/A

Pre-Authorization is Required for Certain Services
Pre-Authorization is Required for Certain Services

 

[munyaku]

@ebbnflow Is bariatric surgery a covered benefit with your employer plan?

 

[ebbnflow]

@munyaku I called uhc and the rep said was a bit confused and then ultimately said yes. I should probably double check before I screw myeslf lol. Is there any way I can confirm for sure in my documentation?

 

[munyaku]

@ebbnflow It should be in the spd or eoc documents. Do you have a benefits dept at work?

 

[ebbnflow]

@munyaku having trouble accessing the docs on uhc.com I can reach out to HR

 

[ladydaffodil]

@ebbnflow My husband's job is switching to UHC starting 1/1.

I found providers as a guest or 'just shopping' by specifying Choice or Choice Plus networks. You would probably need to specify Choice EPO or Choice Plus PPO.

Their search is not easy to use unless you start with the doctor's name

The EPO plan likely requires setting up a PCP and getting referrals