Out of pocket maximum definition.

[SirRavindraJadeja]

Hello folks , what is the definition of out of pocket Max

As per my knowledge this is the amount you pay maximum as copay per year.

 

As per my insurance max out of pocket is 5000 with no roof limit..

 

But however I was been hit with 34,000$ bills.

Can't understand why insurance is not taking responsibility

[sattipandu]

did you call them yet?

[Rushabhi]

If your procedure is not covered by insurance your bill does not come under out of pocket 

[SirRavindraJadeja]

4 minutes ago, Rushabhi said:

If your procedure is not covered by insurance your bill does not come under out of pocket 

Ok same procedure is conducted by doctor eveery day for a month.

 

It was covered one day but was not covered for certain day of the week. It is the same procedure.

Insurance paid 80% and asking to pay remaining.

 

 

My calculation was I will end up paying out of pocket maximum. But this looks otherwise.

[SirRavindraJadeja]

Anyinputs.

[former]

Out of Pocket Maximum In Network - Maximum amount you need to pay from your pocket for a plan year In Network (some exceptions based on your plan)

Out of Pocket Maximum Out Network

Ee rendu vuntayi. nee previous comments prakaram nevu In network doctor daggariki vellavu. But In network lo kuda konni procedures certain times of the year ee cover avuthayi. (Ex: neku 25 vistis to Physiotherapy per Plan year). Oko sari hospital vadu duplication bills vesthadu. Check your EOB & Medical bill procedure dates and amounts.

Call to Insurance & hospital for better understand about the procedures and your plan limits.

[SirRavindraJadeja]

18 minutes ago, former said:

Out of Pocket Maximum In Network - Maximum amount you need to pay from your pocket for a plan year In Network (some exceptions based on your plan)

Out of Pocket Maximum Out Network

Ee rendu vuntayi. nee previous comments prakaram nevu In network doctor daggariki vellavu. But In network lo kuda konni procedures certain times of the year ee cover avuthayi. (Ex: neku 25 vistis to Physiotherapy per Plan year). Oko sari hospital vadu duplication bills vesthadu. Check your EOB & Medical bill procedure dates and amounts.

Call to Insurance & hospital for better understand about the procedures and your plan limits.

Alright so particular patient is in hospital for 30 days. They covered first 10 days and few days in between and last 2 days. For other days patients where asked to pay the bill for same procedure. Amount is ridiculously high...impossible to pay.

[MagaMaharaju]

Ae maata ki aa maata. Health care sucks here

[former]

45 minutes ago, SirRavindraJadeja said:

Alright so particular patient is in hospital for 30 days. They covered first 10 days and few days in between and last 2 days. For other days patients where asked to pay the bill for same procedure. Amount is ridiculously high...impossible to pay.

As I said, please look all the EOB from Insurance and Bills from patients. Note down which day bills covered by insurance and how much amount Insurance paid them to the Hospital. Sometimes, Hospital may be send duplicated bills as well. After your research & work, call to Insurance company and ask about why it does not cover for all 30 days, ask if any Insurance payment differ what you need to pay to the hospital for the same procedure.

Sometimes, different doctor on the same hospital also may be out of network as well. So you need to look into all documents and find out why you got that much amount bill.

The plan with your employer or bought outside? Looks like you had a good Insurance plan since your out of Pocket is 5k. But some plans may have some restrictions to some procedure. So it all depends on your Insurance plan and limits.

[former]

19 minutes ago, MagaMaharaju said:

Ae maata ki aa maata. Health care sucks here

It sucks but if you understand the Insurance EOB docs and medical bills you will understand how it works.

[SirRavindraJadeja]

1 hour ago, former said:

As I said, please look all the EOB from Insurance and Bills from patients. Note down which day bills covered by insurance and how much amount Insurance paid them to the Hospital. Sometimes, Hospital may be send duplicated bills as well. After your research & work, call to Insurance company and ask about why it does not cover for all 30 days, ask if any Insurance payment differ what you need to pay to the hospital for the same procedure.

Sometimes, different doctor on the same hospital also may be out of network as well. So you need to look into all documents and find out why you got that much amount bill.

The plan with your employer or bought outside? Looks like you had a good Insurance plan since your out of Pocket is 5k. But some plans may have some restrictions to some procedure. So it all depends on your Insurance plan and limits.

K. You are very rght. Those days might not be covered as patient was treated by different doctors.

All Desi doctors. Some might be private out of network doctors. In this case can we fight. Actually we personally requested only one docotor to do rounds and checkups however they kept changing provider care.  

[former]

7 hours ago, SirRavindraJadeja said:

K. You are very rght. Those days might not be covered as patient was treated by different doctors.

All Desi doctors. Some might be private out of network doctors. In this case can we fight. Actually we personally requested only one docotor to do rounds and checkups however they kept changing provider care.  

Out of Pocket Maximum - Out network kuda limit vunthudi. Mostly double the amount of In network Out of Packet maximum. So you don't need to end up 34k bill. Talk to insurance customer service.  @SirRavindraJadeja

[krishna0125]

10 hours ago, SirRavindraJadeja said:

K. You are very rght. Those days might not be covered as patient was treated by different doctors.

All Desi doctors. Some might be private out of network doctors. In this case can we fight. Actually we personally requested only one docotor to do rounds and checkups however they kept changing provider care.  

Even if the doctor is out of network, you will also have max out of network right? you should not get huge bill still..and you can fight with hospital for proving out of network doctor..

[SirRavindraJadeja]

On 2/27/2018 at 10:02 AM, krishna0125 said:

Even if the doctor is out of network, you will also have max out of network right? you should not get huge bill still..and you can fight with hospital for proving out of network doctor..

Hi bro..

 

Now they r sending bills for around 700,000$