My wife was recently diagnosed with cancer back in September of 2020.
I have insurance coverage through work which states out of pocket max, say individual “$7,000”.
We are steadily receiving bills from October timeframe that insurance is saying isn’t covered, we have to pay. They’re saying that our out of pocket max wasn’t reached AT that point so they won’t cover it. But once I pay that bill .. I’ll exceed out of pocket max by 5k… How are they still charging us when were paying what we were told to pay?
Money wise, we reached out out of pocket max on DEC 23 but insurance is saying that is false because the provider didn’t submit the claim until after January. (But with this NEW bill from October which is about 5k i would have met the out of pocket max )
Even though the out of pocket wasn’t reached AT that point, it will be once I pay it right?? As that is a bill ..?
Can someone explain what I have to pay, how insurance works? For the new year, if my wife has radiation 5 days a week, say 1200 a day.. we would meet our out of pocket max in one week.
BUT what insurance is saying.. none of that counts towards out of pocket until the CLAIM is sent in. So if the claim isn’t sent in for 30 days.. we have to pay 1200 a day, 5 days a week, for 4 weeks.. they will not go back and cover those services.
Anyhow. This is all confusing to me and probably to you as well as it is hard to explain. I’ve never dealt with this stuff before.
TL;dr I’m f**king confused
submitted by /u/Shafer02
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My wife was recently diagnosed with cancer back in September of 2020. I have insurance coverage through work which states out of pocket max, say individual “$7,000”. We are steadily receiving bills from October timeframe that insurance is saying isn’t covered, we have to pay. They’re saying that our out of pocket max wasn’t reached AT that point so they won’t cover it. But once I pay that bill .. I’ll exceed out of pocket max by 5k… How are they still charging us when were paying what we were told to pay? Money wise, we reached out out of pocket max on DEC 23 but insurance is saying that is false because the provider didn’t submit the claim until after January. (But with this NEW bill from October which is about 5k i would have met the out of pocket max ) Even though the out of pocket wasn’t reached AT that point, it will be once I pay it right?? As that is a bill ..? Can someone explain what I have to pay, how insurance works? For the new year, if my wife has radiation 5 days a week, say 1200 a day.. we would meet our out of pocket max in one week. BUT what insurance is saying.. none of that counts towards out of pocket until the CLAIM is sent in. So if the claim isn’t sent in for 30 days.. we have to pay 1200 a day, 5 days a week, for 4 weeks.. they will not go back and cover those services. Anyhow. This is all confusing to me and probably to you as well as it is hard to explain. I’ve never dealt with this stuff before. TL;dr I’m f**king confused
submitted by /u/Shafer02 [link] [comments]Read Morer/HealthInsurance