A. Stoot 85 Posted June 4, 2014 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
Luvin_Life125 558 Posted June 4, 2014 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
A. Stoot 85 Posted June 4, 2014 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???? 1 Luvin_Life125 reacted to this Share this post Link to post Share on other sites