My plan summary states that I pay 0% and insurance pays 100% of all eligible expenses after I meet my deductible, for everything as long as it’s in-network (plan summary provided by my company: https://imgur.com/OG9YYIu).
So a few questions:
If insurance covers 100% after I meet my deductible, how would I ever reach my OOP maximum? What does “eligible expenses” mean? I am considering a surgery with an in-network surgeon that involves some steps that may not be covered (breast removal, but the liposuction will not be covered). Would that count towards my OOP max? I thought anything not covered just means it doesn’t even pass through insurance. Is my out-of-network deductible separate from my in-network deductible, so that I have two deductibles to meet? So that if I have hit my $2,500 in-network deductible, I still have to pay an additional $2,500 for out-of-network deductible? Strangely, it shows “N/A” for OOP maximum for out-of-network care in my provider’s website (https://imgur.com/Hui10f8). Does this mean there is no maximum and I just have to pay 20% of the out-of-network bill indefinitely until next year?
Thank you!
Album of the screenshots here: https://imgur.com/a/bsfgMEx
submitted by /u/Fun2Work
[link] [comments]
My plan summary states that I pay 0% and insurance pays 100% of all eligible expenses after I meet my deductible, for everything as long as it’s in-network (plan summary provided by my company: https://imgur.com/OG9YYIu). So a few questions:
If insurance covers 100% after I meet my deductible, how would I ever reach my OOP maximum? What does “eligible expenses” mean? I am considering a surgery with an in-network surgeon that involves some steps that may not be covered (breast removal, but the liposuction will not be covered). Would that count towards my OOP max? I thought anything not covered just means it doesn’t even pass through insurance. Is my out-of-network deductible separate from my in-network deductible, so that I have two deductibles to meet? So that if I have hit my $2,500 in-network deductible, I still have to pay an additional $2,500 for out-of-network deductible? Strangely, it shows “N/A” for OOP maximum for out-of-network care in my provider’s website (https://imgur.com/Hui10f8). Does this mean there is no maximum and I just have to pay 20% of the out-of-network bill indefinitely until next year?
Thank you! Album of the screenshots here: https://imgur.com/a/bsfgMEx
submitted by /u/Fun2Work [link] [comments]Read Morer/HealthInsurance