Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Deductible met now what?



Recommended Posts

Had my office visit today with my surgeon and scheduling my EGD, frontera and evaluation. I was told today that my deductible is met, does this mean I will still have out of pocket costs with BCBS, has anyone had to pay both out of pocket and meet deductible? I asked if I was going to talk to someone about costs so I can prepare and I was told it wasn't necessary, so I guess I am confused because my insurance company told me I had 80/20 and I am responsible for 20%, but was told different today by the insurance coordinator.

Share this post


Link to post
Share on other sites

Typically once you meet your deductible, your insurance will start covering a certain % of future claims allowed amount and the rest is due from you until you meet your out of pocket max. For example, my policy has a $3000 deductible and then they cover claims at 80% (meaning I am responsible for the remaining 20%) until I meet my out of pocket max of $5000. So I am responsible for all claims up to the first $3000 of my medical expenses for the year. Now that I have met that $3000, the insurance pays my medical claims at 80%. Once my 20% reaches $5000, my insurance pays all claims after the $5000 in full with no payment due from me. Does that help?

Share this post


Link to post
Share on other sites

Typically once you meet your deductible, your insurance will start covering a certain % of future claims allowed amount and the rest is due from you until you meet your out of pocket max. For example, my policy has a $3000 deductible and then they cover claims at 80% (meaning I am responsible for the remaining 20%) until I meet my out of pocket max of $5000. So I am responsible for all claims up to the first $3000 of my medical expenses for the year. Now that I have met that $3000, the insurance pays my medical claims at 80%. Once my 20% reaches $5000, my insurance pays all claims after the $5000 in full with no payment due from me. Does that help?

Yes it does, thanks a bunch????

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • rinabobina

      I would like to know what questions you wish you had asked prior to your duodenal switch surgery?
      · 0 replies
      1. This update has no replies.
    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×