Any Insurance Guru's Out There?

[ashley624 21]

So I have met my deductible, while also meeting my max out of pocket for the year. Does anyone know if I will have to still pay my copay for surgery even if I met my out of pocket max?

[valdostaGA 149]

According to my insurance BCBS AL once u meet the deductible and OOP Max everything is covered @ 100%

[valdostaGA 149]

I forgot to add that some insurance companies don't count your copays against your OOP Max so call your insurace to be sure because each company as well as policy can be different.

[chitowngirl 886]

It really depends on your policy, some policies will specifically state that copay are not included in your out of pocket max. The best thing to do is call the customer service # on the back of your insurance card and ask.

[Ima Loser 197]

I work in insurance. I know for a fact that Horizon BCBS of NJ does not count your copays towards your MOOP (Max Out of Pocket) Where are you from and what insurance do you have... Each plan even within 1 company has dramatic differences... Your best bet is to call the certification department of your insuance company (member services don't always have a definitive answer) and ask them. Write down EVERYTHING Date and time of call and person you spoke with and ask for a confirmation or call id number... Most Insurance companies will give this if requested. Then you know your account was noted for your call and save all of this info until you recieve you EOBs after surgery... If this is not correct then you have all of the information you were given from your inital call. Oh and if the person you are speaking with seems unsure call back again and ask someone else!!

[sleevemeup 41]

My insurance doesn't allow this surgery to count as oop expenses. So I will still have to pay the co pay.

[Ready4success 380]

I still had a co-pay also, but I didn't bat an eyelash. That was the best 100 bucks I've ever spent.

[ashley624 21]

I have united health care choice plus. I don't have a copayment for surgery I just know I have an 80/20 with the coverage or whatever you call it.

[Isabel'sGma 18]

I also have UHC Choice Plus and had surgery this year. I am also our company's Insurance Benefits Manager. The real answer is, it depends on your plan.

1) If you plan has a surgery or hospitalization "co-pay" - you will have to pay that. If it does not, then the OOP maximum would apply and you should owe nothing. I met my OOP max with my pre-op tests so I owed nothing for my surgery.

2) If you have a Dr's office visit co-pay, that should only apply to your pre-op appointments, but it depends on if they charge a Dr's fee every time you go in for your post-op checks. Mine does not, it is important to ask your surgeon's office if they bill an office visit charge for the post-op visits.

3) If you have met your OOP (out of pocket maximum) for the year, all bills through the end of the year that would normally pay at a % will pay at 100% unless there is a benefit with a specific visit maximum (chiro, naturopath, etc.)

4) Anything with a co-pay, you will still need to pay your co-pay's.

I hope this helps, you can PM me if you want.

[Kidden 1]

I also have UHC Choice Plus and had surgery this year. I am also our company's Insurance Benefits Manager. The real answer is, it depends on your plan.

1) If you plan has a surgery or hospitalization "co-pay" - you will have to pay that. If it does not, then the OOP maximum would apply and you should owe nothing. I met my OOP max with my pre-op tests so I owed nothing for my surgery.

2) If you have a Dr's office visit co-pay, that should only apply to your pre-op appointments, but it depends on if they charge a Dr's fee every time you go in for your post-op checks. Mine does not, it is important to ask your surgeon's office if they bill an office visit charge for the post-op visits.

3) If you have met your OOP (out of pocket maximum) for the year, all bills through the end of the year that would normally pay at a % will pay at 100% unless there is a benefit with a specific visit maximum (chiro, naturopath, etc.)

4) Anything with a co-pay, you will still need to pay your co-pay's.

I hope this helps, you can PM me if you want.

You explained everything really clearly, thank you. Can I ask a similar question? I have met my MOOP and deductible for this year and hope to get a December surgery date because of this. I have a $1,500 copay for any weight loss surgery (yet not other surgeries ) and so my question is when will this copay be collected? I have been approved so the next step is scheduling the surgery. So will the surgeon send the copay bill in the mail? Or is it due the day of surgery like a regular Dr. visit? I'm just confused by this because you will be at the hospital, not the surgeons office. I just want to know when I will have to have the $1,5000 ready bc it is Christmas time and I'm a broke college student Thanks!

[Isabel'sGma 18]

Typically co-pays will be collected prior to or at the time of the service. Most Dr's offices will not bill you for a co-pay. Your hospital may be willing to do that, but I know that mine required my entire out-of-pocket maximum on the date of surgery.

When they verify your benefits and find out that there is a co-pay it will more than likely be required prior to surgery. To be pro-active (because they will find out about it) you could call the hospital billing office and see if they are willing to set up payment arrangements for that amount.

[Kidden 1]

Ah I see. Ok i'll try making arrangements with them asap. Thanks for the advice!