I posted recently about my situation and had a new question that came up. Long story short, wife went into labor early year and a half ago so we went to an in network hospital that was close to us that had a NICU. The NICU (which was inside the hospital and next to the maternity ward) was technically out of network (we had no idea till billing or till he was about to be released), and didn’t really have a choice given it was an emergency.
Insurance was nice enough to pay as in network given it was an emergency and had no choice and that was paid early last summer. Thought we were done, we had to pay a few thousands of dollars of what was remaining but manageable. 6-7 months later we start getting bills for balance billing for around $26K.
I’m trying to work it out and thought at least our Max liability is around $4K because our plan has an out of pocket maximum for in network (which we hit) as well as out of network for a higher limit of around $6. We already hit around $2K of that so 4K remaining. When I was talking to my insurer earlier, they mentioned the services (which are covered in my plan) would not be applicable to the out of pocket maximum.
Is there any reason why my out of pocket maximum for out of network services would not be applicable? Seems like the whole purpose of having an out of pocket maximum for out of service providers.
submitted by /u/0rangePolarBear
[link] [comments]I posted recently about my situation and had a new question that came up. Long story short, wife went into labor early year and a half ago so we went to an in network hospital that was close to us that had a NICU. The NICU (which was inside the hospital and next to the maternity ward) was technically out of network (we had no idea till billing or till he was about to be released), and didn’t really have a choice given it was an emergency. Insurance was nice enough to pay as in network given it was an emergency and had no choice and that was paid early last summer. Thought we were done, we had to pay a few thousands of dollars of what was remaining but manageable. 6-7 months later we start getting bills for balance billing for around $26K. I’m trying to work it out and thought at least our Max liability is around $4K because our plan has an out of pocket maximum for in network (which we hit) as well as out of network for a higher limit of around $6. We already hit around $2K of that so 4K remaining. When I was talking to my insurer earlier, they mentioned the services (which are covered in my plan) would not be applicable to the out of pocket maximum. Is there any reason why my out of pocket maximum for out of network services would not be applicable? Seems like the whole purpose of having an out of pocket maximum for out of service providers. submitted by /u/0rangePolarBear [link] [comments]Read Morer/HealthInsurance