TRS Activecare payment for fills and SCOR

[Poodles 0]

Ok, so my insurance payed 100% of a bill last year, which was $600.00. This year they put things to my deductable, 500, and then paid 60% of the other $100.00 which is $60.00. They put nothing else to a copay.

The lady at BC said that next time they will pay 60% of the allowable amount. So if they bill $600.00 they will be paid around $360.00 next time, not putting anything to a copay. I have paid a copayment each time I have gone in there, and SCOR says that I am responsible for $150.00 per visit.

From my standpoint, I am seeing that I will owe them money this time to add up to the $150.00, but should not have to pay a copay the next time, nor any additional money since they will be paid $360.00. Is this correct?

Does anyone else have experience with out of network benefits/TRS/Fills?

How are you handled?