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Out Of Pocket

What's the max/min anyone has paid out of pocket with insurance?

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Of course, the answers are going to vary depending in the insurance carrier. My personal out of pocket that has to be met is $2,000 before insurance kicks in at 80/20. The maximum OOP is $4,000 with no limits. That's why, after I had my gallbladder removed in February, I'm working to get everything fixed this year. In fact, I'm sitting in bed recovering from surgery to fix my deviated septum. Once I meet all my insurance requirements, I should be sleeved at no additional cost to me.

I have Aetna (actually an employee) and I have a $1600 deductible to be met and then my surgery and all the other things like cardiac and pulmonary clearance and psych eval will all pay at 80/20. Unfortunately I am healthy other than overweight so all my pre-op doctor and psych eval, surgery consult all have to be paid by me .....am hopeful that all of these will have me meet that deductible befor surgery so then I will only have to pay that 20% as I understand I have to prepay that...or maybe I misunderstood....If I have to that's ok I have that money put away.

I have Cigna OAP and my OOP is 2500 which my surgeon wants paid before surgery.

  • Author

Yup that's what I need to prepare for, well I have a few more months before my paperwork gets submitted, so I bet start saving ;)

Have you checked with your insurance company yet? They can give you the exact total you'll have to come up with. Or you'll probably meet with the insurance coordinator on your first visit with the surgeon. They do a pre-authorization and will give you paperwork showing your portion. Good luck!

I have Cigna OAP and my OOP is 2500 which my surgeon wants paid before surgery.

I have Cigna OAP also, and my out of pocket for just me is $1,000. The out of pocket for my family is $3000. I just think $2500 seems like an awful lot for individual.

I'll take the 2500 my out of pocket max is 5000 just for me but with all the appoints and other visits so far I'm at 2000.

I'll take the 2500 my out of pocket max is 5000 just for me but with all the appointments and other visits so far I'm at 2000.

I wish I had that much taken off mine with all my appointments only 400 has gone toward my out of pocket. I was submitted June 5th so im done with appointments, waiting for approval now

My deductible was 750 and its been met. I had a cat scan and an ultra sound and that's what really boosted my out of pocket.

  • Author

Yeah I'm hoping to reach my out of pocket before surgery.

  • 2 weeks later...

I have Cigna and will be covered at 100%. I will have to cover 20% of my psyc eval, and $15 for my nut. Also my surgeon requires an aftercare program that everyone is required to pay for. That will be $500- and is not at all billed to inc.

After I paid $1,000 in out-of-pocket co-insurance amounts, my plan pays 100% (Cofinity) which I have already met for this year.

My insurance coordinator said the only thing I should have to pay is the charge for TV (5.00) if i turn it on.

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