I wouldn't call myself an expert but I have to deal with insurance quite frequently and have picked up a few things. I know that my max out of pocket doesn't run calendar year but the year of the plan which for me is Oct to Oct. Also the insurance doesn't keep track so you have to call and make them check to see if you have hit it or not. You can also tell your dr that you have hit your max and have them resubmit the claim without payment. Hope this helps.
So far towards this pregnancy I have paid $1,200. According to the EOB I just got, when I pay the bill, I'll hit $1,500 (actually I should exceed it) which is my yearly OOP.
So from now on my insurance pays 100% of all costs?
I hit my max in August and haven't paid a penny since. Maximum Out of Pocket is just that in my mind. I refuse payment at my doctors office and tell them I hit my Max. I have had no problems with it. I did have to start paying again after Oct. 15 when my "year" was up. You should find out when your "year" is up and then after you hit your $1500 you shouldn't have to pay anymore until the next "year" hits. Atleast this is how it works with Aetna. I would definitely call though to see when exactly your year is up since it isn't always the calendar year.
So far towards this pregnancy I have paid $1,200. According to the EOB I just got, when I pay the bill, I'll hit $1,500 (actually I should exceed it) which is my yearly OOP.
So from now on my insurance pays 100% of all costs?
I work at a dr's office and that's what should be happening...once you hit your OOP max, you shouldn't have any copays or deductibles or anything! ?You're lucky, not everyone has one of those. ?Do you have a plan year or calender year. ?Hopefully it doesn't start back up in January :0(?
Also make sure there isn't another set of money owed on your plan. With mine with DS I had a $3k deductible + 20% over what the insurance refused to pay. We wound up paying $8k OOP and are still paying a couple of the bills off.
So far towards this pregnancy I have paid $1,200. According to the EOB I just got, when I pay the bill, I'll hit $1,500 (actually I should exceed it) which is my yearly OOP.
So from now on my insurance pays 100% of all costs?
I work at a dr's office and that's what should be happening...once you hit your OOP max, you shouldn't have any copays or deductibles or anything! You're lucky, not everyone has one of those. Do you have a plan year or calender year. Hopefully it doesn't start back up in January :0(
I don't know if it's calendar year or plan year. I need to call my insurance tomorrow and find out. But I do know I have a $0 deductible plan! We have amazing insurance that I have always been incredibly happy with.
I'm pretty sure though that my co-pays don't count towards my OOP max. I have co-insurance (90/10) so I think only the bills I pay towards services count. But again...I'm not totally sure.
Until this year we paid maybe $40 a year in co-pays for doctor visits...then I got pregnant and had all kinds of complications (hospitalization, surgery, etc.) so it's the first time I've really dealt with medical bills!
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
I would check about the copays counting. I also have no deductible and my copays and my prescriptions go towards my max out of pocket. Every plan is different but I've learned to ask every question while I have them on the phone because they will not offer up any information on their own.
I would check about the copays counting. I also have no deductible and my copays and my prescriptions go towards my max out of pocket. Every plan is different but I've learned to ask every question while I have them on the phone because they will not offer up any information on their own.
Good to know! I'll ask about that. Oh, and this is SO true!
I got ONE nice lady while I was in the ER with DH and asking if we were at an in-network hospital and she was offering up all kinds of info (like assuring me that I had ambulance coverage- woo hoo!). I wish I'd gotten her name and extension because I want to talk to her every time!
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
Got it you have a 90/10 insurance deal I was thinking you had a 1500 deductible. is 1500 your max out of pocket for the year?
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
Got it you have a 90/10 insurance deal I was thinking you had a 1500 deductible. is 1500 your max out of pocket for the year?
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
Got it you have a 90/10 insurance deal I was thinking you had a 1500 deductible. is 1500 your max out of pocket for the year?
Yeah, $1500 is my per person OOP max.
HAHAHA Can you tell I was so disturbed by DH's movie choice that I can't read anymore? I just re read the post and your OP says OOP OOPS sorry
Murfy- no worries. For some reason people always assume that everyone has a deductible, which is not true. I have never had an insurance plan with a deductible.
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
Got it you have a 90/10 insurance deal I was thinking you had a 1500 deductible. is 1500 your max out of pocket for the year?
Yeah, $1500 is my per person OOP max.
i'd watch with this. they might (i'm definitely no insurance pro) charge you AND THEN you LO for any expenses.
Once you hit your deductible insurance should kick in 100% the only problem is you need to figure out if your deductible is yearly or a calender year like PP's said. If it starts new every calender year than you might have to pay 1500 to have Jack in the hospital.
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
Got it you have a 90/10 insurance deal I was thinking you had a 1500 deductible. is 1500 your max out of pocket for the year?
Yeah, $1500 is my per person OOP max.
i'd watch with this. they might (i'm definitely no insurance pro) charge you AND THEN you LO for any expenses.
If I'm reading correctly you're saying that they may bill for me and LO separately at birth therefore he'll have a $1,500 OOP max as well? It is true that each person on our plan has an OOP max of $1,500.
If he gets admitted (like to the NICU) then he becomes a separate person and yes, we'll owe a $250 co-pay for him and 10% of the bill.
If he does not get admitted, he is covered under my bill and I'll still only owe $250 which will cover both of us.
It's not a deductible. I have a $0 deductible plan...it's an out of pocket maximum.
ok...that's nice! i only have a deductible but it's a family deductible. i thought my dr's office broke it down into what it would cost for me and then what it would cost for LO. it could just be the way the hospital i'm going to bills.
ok...that's nice! i only have a deductible but it's a family deductible. i thought my dr's office broke it down into what it would cost for me and then what it would cost for LO. it could just be the way the hospital i'm going to bills.
It's probably your insurance I would think, but it may be the hospital.
Because I owe 10% with my co-insurance I am paying $20 to my OB at every visit because this is how they have you pre-pay. It's based on the estimate for an uncomplicated vaginal delivery- so when I deliver I'll have paid the absolute basic charge for a delivery and PP check-up.
Of course if I have an epi or c-section I will incur additional charges...so those will be billed to me after the fact and I'll owe 10% of those bills.
Insurance is confusing and because all plans are different, everyone has a different experience.
I was just talking about this with my sister tonight!
Yeah most do and it sucks! WE have a monthly deductible!!!
Monthly?? How much is it?
1200 a month. Basically we only have the insurance for when I deliver because 1200 is less than 80k or whatever it would be! I never meet the 1200 a month :-(
Yeah most do and it sucks! WE have a monthly deductible!!!
Monthly?? How much is it?
1200 a month. Basically we only have the insurance for when I deliver because 1200 is less than 80k or whatever it would be! I never meet the 1200 a month :-(
I don't know deductibles very well but....does that mean you have to pay $1,200 each month for services billed before your insurance pays anything??
Yeah most do and it sucks! WE have a monthly deductible!!!
Monthly?? How much is it?
1200 a month. Basically we only have the insurance for when I deliver because 1200 is less than 80k or whatever it would be! I never meet the 1200 a month :-(
I don't know deductibles very well but....does that mean you have to pay $1,200 each month for services billed before your insurance pays anything??
Yeah most do and it sucks! WE have a monthly deductible!!!
Monthly?? How much is it?
1200 a month. Basically we only have the insurance for when I deliver because 1200 is less than 80k or whatever it would be! I never meet the 1200 a month :-(
I don't know deductibles very well but....does that mean you have to pay $1,200 each month for services billed before your insurance pays anything??
Check to see if you have a family OOP. Sometimes there is an individual OOP that needs to be and a family OOP. If the family OOP is met, then the individual OOP does not need to be met. Example, you, your husband, and child each have a individual OOP of 1500.00, but you have a family OOP of 3500.00 if 3000.00 is met, all you would have left to meet is 500.00. Most insurance plans have family OOP. Also check to see if you have a stop loss, which works a little differently, if you do have one, be sure to ask your insurance how it works.
MrsRebecca
member
Re: Anyone know insurance well?
I wouldn't call myself an expert but I have to deal with insurance quite frequently and have picked up a few things. I know that my max out of pocket doesn't run calendar year but the year of the plan which for me is Oct to Oct. Also the insurance doesn't keep track so you have to call and make them check to see if you have hit it or not. You can also tell your dr that you have hit your max and have them resubmit the claim without payment. Hope this helps.
So far towards this pregnancy I have paid $1,200. According to the EOB I just got, when I pay the bill, I'll hit $1,500 (actually I should exceed it) which is my yearly OOP.
So from now on my insurance pays 100% of all costs?
I hit my max in August and haven't paid a penny since. Maximum Out of Pocket is just that in my mind. I refuse payment at my doctors office and tell them I hit my Max. I have had no problems with it. I did have to start paying again after Oct. 15 when my "year" was up. You should find out when your "year" is up and then after you hit your $1500 you shouldn't have to pay anymore until the next "year" hits. Atleast this is how it works with Aetna. I would definitely call though to see when exactly your year is up since it isn't always the calendar year.
I work at a dr's office and that's what should be happening...once you hit your OOP max, you shouldn't have any copays or deductibles or anything! ?You're lucky, not everyone has one of those. ?Do you have a plan year or calender year. ?Hopefully it doesn't start back up in January :0(?
I don't know if it's calendar year or plan year. I need to call my insurance tomorrow and find out. But I do know I have a $0 deductible plan! We have amazing insurance that I have always been incredibly happy with.
I'm pretty sure though that my co-pays don't count towards my OOP max. I have co-insurance (90/10) so I think only the bills I pay towards services count. But again...I'm not totally sure.
Until this year we paid maybe $40 a year in co-pays for doctor visits...then I got pregnant and had all kinds of complications (hospitalization, surgery, etc.) so it's the first time I've really dealt with medical bills!
I don't have a deductible.
ETA: I should owe $250 for my hospital stay plus 10% of billed services above the amount I've already pre-paid. My OB is already paid but I know we'll see a pedi, there will be an anesthesiologist, etc.
Good to know! I'll ask about that. Oh, and this is SO true!
I got ONE nice lady while I was in the ER with DH and asking if we were at an in-network hospital and she was offering up all kinds of info (like assuring me that I had ambulance coverage- woo hoo!). I wish I'd gotten her name and extension because I want to talk to her every time!
Got it you have a 90/10 insurance deal I was thinking you had a 1500 deductible. is 1500 your max out of pocket for the year?
Yeah, $1500 is my per person OOP max.
HAHAHA Can you tell I was so disturbed by DH's movie choice that I can't read anymore? I just re read the post and your OP says OOP OOPS sorry
i'd watch with this. they might (i'm definitely no insurance pro) charge you AND THEN you LO for any expenses.
If I'm reading correctly you're saying that they may bill for me and LO separately at birth therefore he'll have a $1,500 OOP max as well? It is true that each person on our plan has an OOP max of $1,500.
If he gets admitted (like to the NICU) then he becomes a separate person and yes, we'll owe a $250 co-pay for him and 10% of the bill.
If he does not get admitted, he is covered under my bill and I'll still only owe $250 which will cover both of us.
It's not a deductible. I have a $0 deductible plan...it's an out of pocket maximum.
major boo!
It's probably your insurance I would think, but it may be the hospital.
Because I owe 10% with my co-insurance I am paying $20 to my OB at every visit because this is how they have you pre-pay. It's based on the estimate for an uncomplicated vaginal delivery- so when I deliver I'll have paid the absolute basic charge for a delivery and PP check-up.
Of course if I have an epi or c-section I will incur additional charges...so those will be billed to me after the fact and I'll owe 10% of those bills.
Insurance is confusing and because all plans are different, everyone has a different experience.
I was just talking about this with my sister tonight!
Monthly?? How much is it?
1200 a month. Basically we only have the insurance for when I deliver because 1200 is less than 80k or whatever it would be! I never meet the 1200 a month :-(
I don't know deductibles very well but....does that mean you have to pay $1,200 each month for services billed before your insurance pays anything??
Yeah
Ouch, I'm sorry murf =(