General Question Re: Out Of Pocket

[mufasas-mom 170]

OK - just checked my online account with UHC and I have already hit my deductive and already met my out of pocket maximum of $2500 - so my question is - when i get the lapband is all i'm required to pay for is the 20% (ins. 80%)? or nothing since I've hit my maximum out of pocket already?? not clear on how that all works.....

[Charda 14]

Nothing you hit your out of pocket.....GO YOU.....

[mufasas-mom 170]

oh yea....GO ME.....yippee - this is awesome.... I also double checked online to make sure....so this means no copay for psych exam - bloodwork and such.... wowzers.

[NWgirl 574]

Sometimes co-pays are different. The office may collect and then repay you because they do not call and get most up to date info when you go in.

[SageTracey 608]

I would get it in writing from your insurer with specific reference to your membership, your status, surgery, co-pays etc. Then you are not relying on your own interpretation and have it in writing to back up any issues you may have. Good luck.

[mufasas-mom 170]

OK here is the note i got back from United Healthcare: My question is - it says I'm still required to pay any co-pays....so, if I'm reading this correctly - my out of pocket max may be $2500 - but I could still end up paying over $5000 (just an example) out of pocket for the year... this is so confusing to me....guess I'm a moron - but I don't get it. what the heck good is having a maximum on out of pocket if it's really NOT actually what you would pay in a given year??

So - I guess I still have to come up with the 20% of the surgery?? Need to look at cashing out he 401K I guess....ugh - was so excited now my little happy balloon is deflated.

Date: 05/09/2012 From: UHC Subject: Re: Out of Pocket Max - reached (KMM1089820V82888L0KM) Message:

Dear Diane,

Thank you for contacting UnitedHealthcare! I received your request about your out-of-pocket maximum.

Once you have reached your deductible and out-of-pocket maximum all covered health services will be paid at 100% of the eligible expenses.

I am showing that you have satisfied your network deductible and out-of-pocket maximum. The deductible and out-of-pocket maximum run on a calendar year basis, so they will start over come January 1, 2013. As long as all covered health services are received by network providers they will be paid at 100% of the eligible expenses until December 31, 2012.

Please be aware that you are still required to pay any necessary copays.

Payment decisions are based on your plan document. They are also based on the patient’s coverage when the service was received and billed by the doctor or facility.

Please do not hesitate to contact us again with any further questions. We are happy to help you.

Thank you for using Secure Messaging. I hope you have a nice day and wish you the best of luck on this process!

Sincerely,

Mandi K., UnitedHealthcare

[NWgirl 574]

Most insurances require a co-pay amount anytime you visit a Dr, luckily mine did not. This means you may have a copay amount due for hospital stays as well.

Usually hospitals bill after the procedure is completed, so if you are going to a hospital you shouldn't have to pay up front. If you are going to a private practice, that may be different.

[mufasas-mom 170]

I have no 'co pays' with my insurance - just the full amount if the deductible has not been met - then 20% afterwards. But I'm still freaking confused.... I think I'll just call UHC and speak to someone otherwise I'll just drive myself nuts.....sucks being a control freak

[mufasas-mom 170]

ok - just got off the phone with a UHC rep who looked up my info and I'm good to go... there are no copays with my plan (which i didn't think i had) unless it's for the emergency room visit of $100/visit. SO I don't have to pay a penny anymore.....goodness I can sleep well tonight! Now hurry up last 3 visits!!

[NWgirl 574]

Out of pocket max should mean that is the max you will pay all year, unless you use an out of network provider. Call your insurance company if you need clarification because they are the only ones who can tell you for sure what is expected.

[rascodr 2]

Did I see that u said the hospital actually bills u for ur portion after the surgery once the insurance pays their part I will get a bill for my part or do I have to pay whatever is my portion up front it looks like the Max I would pay pending approval is $2500 and that could be less due to all that ive paid for Dr visits and lab test

DeAna