Insurance Finally Verified...have a question

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Finally got my Anthem Blue Cross policy requirements confirmed. Standard 6 months of nutrition visits (should be done in May), psych evaluation in April and a $3500 out of pocket maximum which I have no idea what that exactly means. Google describes OOP max as the maximum amount you have to pay out of pocket (copays/deductibles/coinsurance) before everything is covered at 100%...which makes sense. Benefits lady has me confused and they won’t be back in the office until next week. In her email she made it sound like I have to pay all that before surgery. Anyone have any insight and/or tips on this? Do I need to start saving $$$? 😖

[ByronLV 16]

That sounds like it would be correct. I know they are collecting my OOP just before surgery.

[sillykitty 10,776]

19 minutes ago, Kimmie K said:

Finally got my Anthem Blue Cross policy requirements confirmed. Standard 6 months of nutrition visits (should be done in May), psych evaluation in April and a $3500 out of pocket maximum which I have no idea what that exactly means. Google describes OOP max as the maximum amount you have to pay out of pocket (copays/deductibles/coinsurance) before everything is covered at 100%...which makes sense. Benefits lady has me confused and they won’t be back in the office until next week. In her email she made it sound like I have to pay all that before surgery. Anyone have any insight and/or tips on this? Do I need to start saving $$$? 😖

Yes, that was my experience.

[notmyname 593]

I have a different Blue Cross plan. Under my plan, the out of pocket max is the max I'd pay in a year for all services - its intended as a safeguard if you have a catastrophic injury or illness. That was different than what I paid for any given service. Does your blue cross plan have a SErvice Benefit Brochure online? If so, it will likely list bariatric surgery and say what you need to pay depending on if the doc and hospitals are preferred providers or not. Also, note that this cost is JUST for the hospitalization. I ended up with costs for the hospital, surgeon, anesthesiologist, and lab work. It was far lower than my out of pocket max.

I saw three surgeons before I decided on surgery, the only one that would have required me to make such a big payment up front was someone who did not take insurance and was covered as a non-participating provider.

Again, my insurance may work differently than yours.