OMG! Good news at last! Also, jargon help?

[wendy645 1]

:confused:

So after 7 years... yes... seven YEARS... without insurance that will cover this, I finally got a county job with amazing BCBS coverage that includes WLS! I had to work VERY hard to contain myself and not do a happy dance on the table in front of me- including some very funny moves- in employee orientation when I saw the line for Bariatric Surgery!

Because of their policy, my benefits don't kick in until the first day of the month following a full calendar month after my first day. A whole lot of fancy words to say I started in November, add a month puts it in December, then the next first day is January 1st. New Year. New chance! Couldn't be more perfect!

http://www.napebt.com/summaries/2009_medical_ppo_500_summary.pdf

Here is the paper I'm referring to for the following questions:

So since I'm new to having insurance I have to pay something other than copay up front for, can someone help me figure this out? It says, "$1,000 access fee, 80%/20% after meeting deductible." It says my maximum coinsurance is $3,000,and elsewhere in the booklet it says that the 20% coinsurance is based on their allowable amount, not the amount of the bill. And I've heard the allowable amount is lower because insurance companies don't want to pay as much as the hospital bills, and the hospitals are happy to get paid anything so they go along with it. Is this right? And I have a $250 deductible. Does this mean that I would end up paying the $250 deductible, the $1,000 access fee, and $3,000 max out-of-pocket co-insurance, bringing my total to $4,250? Are there other costs associated with this that I don't know about? I want to know as much as I can up front.

I can't call the insurance reps and talk to them about it yet because I am not insured yet, so they can't look up the policy. At least that was my experience with my last insurance company. And the HR rep said it'd be the same case here.

So anyone have experience here? Any words of wisdom? Thanks so much for reading!