My individual out of pocket maximum is less than my family only deductible. Providers can’t seem to figure this out!

When I selected my health plan I THOUGHT it had a $5k individual deductible and a $10k family deductible. I was wrong. But it does have a $6450 individual out of pocket max which made it not so bad. I’m not even convinced this wasn’t a mistake. Insurance has been paying out at 100% since my spouse reached that threshold, but providers can’t seem to get their minds around it and want me to pay 100% of the allowed amount at time of service.

I’m still waiting on a $5600 refund from the hospital, they wouldn’t schedule the surgery until we paid the full 10k deductible and 20% coinsurance up to the family out of pocket max (math doesn’t add up, but they implied we were reaching the family max). They said they were refunding the credit card 12 days ago and the website stopped showing a credit balance, but I still don’t have a credit on the card.

Anyone else run into an out of pocket max lower than the deductible? What were your experiences.

I’m in Texas and the insurance is from Massachusetts.

submitted by /u/CharlieTX
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When I selected my health plan I THOUGHT it had a $5k individual deductible and a $10k family deductible. I was wrong. But it does have a $6450 individual out of pocket max which made it not so bad. I’m not even convinced this wasn’t a mistake. Insurance has been paying out at 100% since my spouse reached that threshold, but providers can’t seem to get their minds around it and want me to pay 100% of the allowed amount at time of service. I’m still waiting on a $5600 refund from the hospital, they wouldn’t schedule the surgery until we paid the full 10k deductible and 20% coinsurance up to the family out of pocket max (math doesn’t add up, but they implied we were reaching the family max). They said they were refunding the credit card 12 days ago and the website stopped showing a credit balance, but I still don’t have a credit on the card. Anyone else run into an out of pocket max lower than the deductible? What were your experiences. I’m in Texas and the insurance is from Massachusetts.
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