Hi!
I just went through a situation that I'm not sure I understand so hoping I can get some guidance from the community.
I have a plan with BCBSIL with:
– $1,000 deductible
– $3,000 max out-of-pocket
I have an ER bill for which the patient responsibility is $2,500, from which:
– $1,000 went to deductible
– $1,500 was my coinsurance amount
BCBSIL is saying that my max out-of-pocket amount to date is only $1,500, when I expected the amount to be $2,500 (which would include deductible + coinsurance).
BCBSIL actually had my spending for max out-of-pocket as $2,500 but they say they'll adjust it because there was an error.
Their explanation is that the deductible and max out-of-pocket are 2 different buckets and what you paid to reach your deductible is not included in your max out-of-pocket bucket.
I don't see any mention of this in my policy, and from previous experience with a different insurance company, the deductible amount counts towards your max out-of-pocket.
Any help on this would be greatly appreciated as I'm not sure if I'm wrong here or if there's a misunderstanding on BCBSIL's side.
Deductible + max out-of-pocket question
byu/emerinohdz inInsurance
Posted by emerinohdz