Hi!
I’m researching plans for Georgia and am currently leaning towards an Ambetter plan. Based on my income, credits, etc, the plan I’m looking at has an out of pocket max of $1400. However, when I’m looking at the details of the plan, it says “Out of pocket max does not include premiums, and balance-billing charges.” I’m fine with it not covering the premium – I knew that part.
On healthcare.gov the definition for balance – billing:
“When a provider bills you for the balance remaining on the bill that your plan doesn’t cover. This amount is the difference between the actual billed amount and the allowed amount. For example, if the provider’s charge is $200 and the allowed amount is $110, the provider may bill you for the remaining $90. This happens most often when you see an out-of-network provider (non-preferred provider). A network provider (preferred provider) may not bill you for covered services.”
I understand this would happen when going out of network, but what worries me is that it says “this happens MOST often out of network”….is this a loophole for me being charged and paying more out of pocket while going in network?
I’m just trying to see if anyone has had any experience with this (or any insight into balance-billing IN network) before I commit to this plan.
Thanks in advance!
submitted by /u/alycat80
[link] [comments]
Hi! I’m researching plans for Georgia and am currently leaning towards an Ambetter plan. Based on my income, credits, etc, the plan I’m looking at has an out of pocket max of $1400. However, when I’m looking at the details of the plan, it says “Out of pocket max does not include premiums, and balance-billing charges.” I’m fine with it not covering the premium – I knew that part. On healthcare.gov the definition for balance – billing: “When a provider bills you for the balance remaining on the bill that your plan doesn’t cover. This amount is the difference between the actual billed amount and the allowed amount. For example, if the provider’s charge is $200 and the allowed amount is $110, the provider may bill you for the remaining $90. This happens most often when you see an out-of-network provider (non-preferred provider). A network provider (preferred provider) may not bill you for covered services.” I understand this would happen when going out of network, but what worries me is that it says “this happens MOST often out of network”….is this a loophole for me being charged and paying more out of pocket while going in network? I’m just trying to see if anyone has had any experience with this (or any insight into balance-billing IN network) before I commit to this plan. Thanks in advance!
submitted by /u/alycat80 [link] [comments]Read Morer/HealthInsurance