Weird insurance question!

[Stephanielp 120]

I had to pay 1200 to the Dr office and then 600 for hospital admit... got a bill yesterday for 239 in the mail from the surgeon office...doesnt seem like I should have to pay so much but my deductible is met for the year at least

progress starts in the mind

[Stephanielp 120]

And that was before I got the surgery

progress starts in the mind

[GMen88 70]

I have to pay $1000 day of my surgery. I'll be billed the remaining $1000 after surgery. That's my 10% I have to pay. Insurance pays the remaining 90%

[Rblack171 10]

This confuses me because my deductible is a $1000 and out of pocket max is $3500. I know I have to pay something upfront just don't know if it will be $1000 or the $3500.

[Mandybb 183]

This confuses me because my deductible is a $1000 and out of pocket max is $3500. I know I have to pay something upfront just don't know if it will be $1000 or the $3500.

So your deductible has to be met before the insurance will pay, so that for sure needs to be met prior to surgery (most doctors work this way). This is where it depends on the individual surgeon on what they require. Let's say, after your deductible, you are responsible for 20% and the insurance covers the other 80%. The max out of your pocket would be $3500 before the insurance covers your surgery 100%. Some offices make you pay the max out of pocket and some bill you after. Just call and ask so they can tell you a for sure amount.

[Rblack171 10]

17 minutes ago, Mandybb said:

So your deductible has to be met before the insurance will pay, so that for sure needs to be met prior to surgery (most doctors work this way). This is where it depends on the individual surgeon on what they require. Let's say, after your deductible, you are responsible for 20% and the insurance covers the other 80%. The max out of your pocket would be $3500 before the insurance covers your surgery 100%. Some offices make you pay the max out of pocket and some bill you after. Just call and ask so they can tell you a for sure amount.

I went to my appointment today I asked and she said I can let you know closer to surgery. I know I will have to pay upfront but I got confused because the one nurse kept saying the deductible but then she said I'm not the insurance guru.