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Self employed people who pay for their own health insurnace via Blue Shield PPO & use Cedars, how much are your co-pays before your deductibles are met?
Had a cardiologist visit and he spent a while talking to me, going over my history, This was the 1st visit.
Blue ShieldBilled to Insurance $921.00
Insurance Covered-$440.05
Remaining Responsibility$480.95
And below was a telemedine with Cedars. I just talked to the guy for 7 min
Blue ShieldBilled to Insurance$351.00
Insurance Covered-$161.11
Remaining Responsibility$189.89
Not Covered$189.89
Is it normal for a copay to be $189 for in-network telemedicine?
I don't have money problems and can afford it no problem. I'm just wondering if this is normal and how much copays are for other self employed folks? Cause our insurance is way more expensive and worse than for those who get it through work.
I actually called Blue Shield to ask them exactly how my copays are determined before I met the deductible and they were not able to answer me! They legit don't know! From both of these visits it looks like I'm responsible for around 50% until my deductible is met. Is that right?
honestly the part nobody's hitting is that Cedars has its own financial assistance / charity care program and a lot of self employed people assume they won't qualify. Their cutoff goes higher than you'd think, and if you're on a Bronze plan with that deductible they'll sometimes knock down the remaining responsibility or set up a payment plan at 0%. Worth calling their billing office directly, not Blue Shield.
also for the telemedicine, check if it was actually billed as a specialist visit vs a facility charge. i had a similar thing where a 6 min Cedars video call got coded as outpatient hospital and my jaw dropped. if you call and ask for the CPT code and the place of service code, a lot of times they'll rebill it as a regular office visit and the allowed amount drops by half.
fwiw i'm self employed too and switched my cardio follow ups to a private practice doc in Glendale who's still Cedars affiliated. same quality, allowed amount was like 40% less. the Cedars name on the building is what you're paying for.
Cedars is the expensive part of this equation, not Blue Shield. They're a hospital-based system so every visit gets billed with a facility fee attached, even a 7 minute video call. If you ran that same telemedicine visit through a standalone group like UCLA Health's community clinics or a private practice in, say, Pasadena, the allowed amount would likely be $150 to $200 total instead of $351, and your 50% would be $75 to $100.
The 50% coinsurance on Bronze is standard, you've got that part right. What varies is the allowed amount, and Cedars negotiates high rates because they can. For a cardiologist first visit with a real history review, $921 billed is normal for them, and $480 out of pocket pre-deductible tracks.
One thing worth doing since you're self employed and not tight on cash: look at whether a Silver PPO pencils out. The premiums run maybe $150 to $250 more a month for a similar plan, but the coinsurance drops to something like 30% and you'd get cost sharing reductions on some plans if your income qualifies. Run your actual claim history through it, two Cedars specialists a year and it can flip in Silver's favor fast.
The 50% is right for Bronze pre-deductible, but the number that's actually biting you is the allowed amount, not the split. Cedars bills through the hospital, so a specialist visit gets coded as a hospital outpatient encounter and the allowed amount balloons. A private cardiologist in Beverly Hills or even a Cedars-affiliated doc in a standalone office on Roxbury would likely have an allowed amount half that.
The telemedicine thing is the tell. $351 allowed for 7 min is a facility fee, plain and simple. If you use Blue Shield's telehealth benefit instead of Cedars' platform, most Bronze PPOs cover it at a flat $0 to $15 even before the deductible, because it's not billed as hospital outpatient. Worth checking your Evidence of Coverage PDF, the telehealth section is usually on page 20-something.
For the self-employed math: your $600/month Bronze is actually on the cheaper end for a solo PPO in LA. The tradeoff is exactly this, high allowed amounts at hospital systems plus 50% coinsurance. If you're going to keep using Cedars specialists, a Silver PPO at around $780/month usually drops coinsurance to 30% and can pay for itself after two or three specialist visits. Run your actual claims through Covered California's plan compare, it'll show you the real out of pocket per plan, not the sticker.
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How can I find mobile hot dog vendors for a private event?
honestly the SGV has a ton of licensed cart operators who mostly do private stuff now. look up "hot dog cart catering San Gabriel Valley" on Yelp and you'll get a handful that are fully permitted, which matters if your venue needs a health permit on file. expect around $400 to $700 for a few hours plus a per person minimum, usually 50 or so. the ones based in Alhambra and Rosemead tend to be cheaper than Pasadena because they're not paying that rent.
fwiw the county health dept keeps a public list of permitted mobile food operators, its searchable by city on the LA County Public Health site. filter for "pushcart" or "MFF" and you'll get vendors cleared for SGV zip codes, which saves you the headache of a venue asking for paperwork later. also worth checking with the Old Town Monrovia or Alhambra farmers market folks, the carts there are usually booked solid but they know who's free and they'll pass along names. just dont wait till the last week, good ones book out 2 to 3 weeks in teh summer.
You could try hitting up the folks who set up outside Home Depot or the DMV in El Monte on weekends, a lot of those carts are owner operated and they'll do private gigs if you ask. Just walk up and grab a card, they usually have one taped to the cart.