I work and have my wife and 3 kids on my health insurance plan. Going in to this year we knew we had some big expenses coming up for one of the members of the family but figured we would just hit the OOP Maximum and budget for that.
Plan Details:
In-Network Deductible: 3,000
Out-Of-Network Deductible: 6,000
In-Network Individual Out-Of-Pocket Maximum: $4,000
In-Network Family Out-Of-Pocket Maximum: $8,000
Out-Of-Network Individual Out-Of-Pocket Maximum: 10,000
Out-Of-Network Family Out-Of-Pocket Maximum: 20,000
Surgery was completed and deductible was met and I thought i wouldn’t be receiving anymore bills for this family member as they also were showing more than 4,000 towards their max out of pocket. However when I looked at the insurance providers website it shows that the individual max-out-of-pocket in-network is $8,000(incorrect according to SBC) and the max-out-of-pocket out of network as $10,000 (correct according to SBC)
I called the insurance company and they stated that it was very clear in their agreement with our corporate office and it sounded like I needed to talk with the company benefits person to work this out. I’m still working on tracking this down however want to know if I’m misinterpreting the summary of benefits.
submitted by /u/Original_Sandwich585
[link] [comments]
I work and have my wife and 3 kids on my health insurance plan. Going in to this year we knew we had some big expenses coming up for one of the members of the family but figured we would just hit the OOP Maximum and budget for that. Plan Details: In-Network Deductible: 3,000 Out-Of-Network Deductible: 6,000 In-Network Individual Out-Of-Pocket Maximum: $4,000 In-Network Family Out-Of-Pocket Maximum: $8,000 Out-Of-Network Individual Out-Of-Pocket Maximum: 10,000 Out-Of-Network Family Out-Of-Pocket Maximum: 20,000 Surgery was completed and deductible was met and I thought i wouldn’t be receiving anymore bills for this family member as they also were showing more than 4,000 towards their max out of pocket. However when I looked at the insurance providers website it shows that the individual max-out-of-pocket in-network is $8,000(incorrect according to SBC) and the max-out-of-pocket out of network as $10,000 (correct according to SBC) I called the insurance company and they stated that it was very clear in their agreement with our corporate office and it sounded like I needed to talk with the company benefits person to work this out. I’m still working on tracking this down however want to know if I’m misinterpreting the summary of benefits.
submitted by /u/Original_Sandwich585 [link] [comments]Read Morer/HealthInsurance