If you meet your out of pocket maximum & you need a procedure or surgery that is normally cocovered by insurance & is in network, can ins deny it because they don't want to pay it at 100%? Im worried I'll need surgery & ins will deny it because they will have to pay it at 100%. Seems unethical, but I'm not sure my rights or theirs. Thank you!!
That means the co-insurance is like your deductible. That is the amount you pay for your services until you reach the oop. So, let’s say your co-insurance is you pay 20% of the bill and your insurance pays 80% of the bill. You will pay for services in that format until you reach your OOP max. Once you have paid the OOP max, your insurance then pays 100% unlike before where they paid only 80%.
It's very helpful, the way you use very easy to understand
Glad it was helpful!
If you meet your out of pocket maximum & you need a procedure or surgery that is normally cocovered by insurance & is in network, can ins deny it because they don't want to pay it at 100%? Im worried I'll need surgery & ins will deny it because they will have to pay it at 100%. Seems unethical, but I'm not sure my rights or theirs. Thank you!!
Your advice about timing appointments is so good, it took me a minute to realize that's implicit in how deductibles work.
Thank you so much ! You explain them so well :)
I have started to work in Health insure and l feel really complicated to handle all this :(
Thank you!
Explained quite well, with examples
What does it mean when you have a coinsurance maximum of $2000 and an OOPM of $7500?
That means the co-insurance is like your deductible. That is the amount you pay for your services until you reach the oop.
So, let’s say your co-insurance is you pay 20% of the bill and your insurance pays 80% of the bill.
You will pay for services in that format until you reach your OOP max. Once you have paid the OOP max, your insurance then pays 100% unlike before where they paid only 80%.