Insurance coverage changing on last month of diet.

[Bellasoo 45]

Hi all,

I am so confused here. When I started my program I had a $250 deductible per year and zero out of pocket. I was responsible for 10% of my surgical cost plus office co-pays. I just learned today that this is changing, on May 1st, to a $500 deductible, a $2000 out of pocket maximum, 20% of which I am responsible for up to that maximum, and a 10% surgical co-pay. So am I reading this right? Will I have to pay my $2500 plus the %10 of the surgery? Or will it stop at the out of pocket max?

Thanks to anyone who responds.

[Sleeve1stFitNext 924]

So your plan has a $500 deductible and 10% co-insurance and you use $25,000 in services, you'll pay the $500 plus 10% of the remaining $24,500, up to your out-of-pocket maximum.

You should not owe them any additional. So you should be paying $2,500 max out of pocket. Your surgical co-pay should be included in your out-of-pocket maximum.

However, you should contact your insurance company as they may have different rules regarding this part of your medical.

My insurance did not have a surgical co-pay. I have a $500 deductible with a $2,000 out-of-pocket maximum.

[Bellasoo 45]

Yeah, that is the only thing that is throwing me off. I just figured that you don't go over that maximum. It's very confusing to me and it does not help that they won't answer any questions about it because the new policy is not in place yet.

[SleeveinIL 386]

Typically you only pay up to the out of pocket maximum which will include your deductible.