United HC Question

[chloemom 0]

O.K. my deductible (in network) is $1,000. Then 80/20 up to $2,000. What does this mean? Am I going to pay $3,000 or $2,000 or just the deductible. Can someone explain this to me in kindergarten terms. I just don't get it..

Thanks

[mom007 0]

I'm actually not sure. I have UHC too and my deductible is $250 with a max out of pocket of $2500. When I met with the insurance coordinator she told me my portion of the surgery would be "about $2800". WTF? If my max out of pocket is $2500 how can I have to pay $2800?

I used to do payroll only so my limited understanding of insurance was you meet your deductible ($1000) then pay the 20% in addition to that up to your max out of pocket.

So by my math a $15000 surgery would be:

$15000 - surgery

less $1000 - deductible

= $14000 x 20%

= $2800

but if your max out of pocket is $2000 you should only have to pay your deductible plus $1000 of the $2800 (20%) balance. Leaving $1800 paid by the insurance company?

If I'm wrong someone let me know. But that's how my logic works!

[mom007 0]

P.S. my daughter's name is Chloe! I just love that name!

[loseit7 0]

It varies by plan, I think. If you go to myuhc.com and start an account (if you don't already have one) you should be able to go to the "My Benefits" section and click on the "Out of Pocket Maximum" link and it will tell you the definition specific to your plan. But, generally speaking, your deductible does go towards your out of pocket maximum, so you would pay a maximum of $2,000 for the surgery I would think.