Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Deductible met now what?



Recommended Posts

Had my office visit today with my surgeon and scheduling my EGD, frontera and evaluation. I was told today that my deductible is met, does this mean I will still have out of pocket costs with BCBS, has anyone had to pay both out of pocket and meet deductible? I asked if I was going to talk to someone about costs so I can prepare and I was told it wasn't necessary, so I guess I am confused because my insurance company told me I had 80/20 and I am responsible for 20%, but was told different today by the insurance coordinator.

Share this post


Link to post
Share on other sites

Typically once you meet your deductible, your insurance will start covering a certain % of future claims allowed amount and the rest is due from you until you meet your out of pocket max. For example, my policy has a $3000 deductible and then they cover claims at 80% (meaning I am responsible for the remaining 20%) until I meet my out of pocket max of $5000. So I am responsible for all claims up to the first $3000 of my medical expenses for the year. Now that I have met that $3000, the insurance pays my medical claims at 80%. Once my 20% reaches $5000, my insurance pays all claims after the $5000 in full with no payment due from me. Does that help?

Share this post


Link to post
Share on other sites

Typically once you meet your deductible, your insurance will start covering a certain % of future claims allowed amount and the rest is due from you until you meet your out of pocket max. For example, my policy has a $3000 deductible and then they cover claims at 80% (meaning I am responsible for the remaining 20%) until I meet my out of pocket max of $5000. So I am responsible for all claims up to the first $3000 of my medical expenses for the year. Now that I have met that $3000, the insurance pays my medical claims at 80%. Once my 20% reaches $5000, my insurance pays all claims after the $5000 in full with no payment due from me. Does that help?

Yes it does, thanks a bunch????

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • BeanitoDiego

      I've hit a stall 9 months out. I'm not worried, though. My fitness levels continue to improve and I have nearly accomplished my pre-surgery goal of learning to scuba dive! One dive left to complete to get my PADI card 🐠
      I was able to go for a 10K/6mile hike in the mountains two days ago just for the fun of it. In the before days, I might have attempted this, but it would have taken me 7 or 8 hours to complete and I would have been exhausted and in pain for the next two days. Taking my time with breaks for snacks and water, I was finished with my wee jaunt in only 4 hours 😎 and really got to enjoy photographing some insects, fungi, and turtles.
      Just for fun last week, I ran two 5Ks in two days, something I would have never done in the past! Next goal is a 10K before the end of this month.
      · 0 replies
      1. This update has no replies.
    • Teriesa

      Hi everyone, I wrote back in May about having no strength. I still get totally exhausted just walking from room to room, it’s so bad I’m using a walker with wheels of all things. I had the gastric sleeve Jan. 24th. I’m doing exactly what the programs says, except protein shakes. I have different meats and protein bars daily, including vitamins daily. I do drink my fluids as well.  I go in for IV hydration 4 days a week and feel ok just til evening.  So far as of Jan 1st I’ve dropped 76 lbs. I just want to enjoy the weight lose. Any suggestions or has anyone else gone thru this??  Doctor says just increase calorie intake, still the same. 
      · 0 replies
      1. This update has no replies.
    • Stone Art By SKL

      Decorative Wall Cladding & Panels | Stone Art By SKL
      Elevate your space with Stone Art By SKL's decorative wall claddings & panels. Explore premium designs for timeless elegance.
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Losing my hair in clumps and still dealing with "stomach" issues from gallbladder removal surgery. On the positive side I'm doing better about meeting protein and water goals and taking my vitamins, so yay? 🤷‍♀️
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      I've hit a stall 9 months out. I'm not worried, though. My fitness levels continue to improve and I have nearly accomplished my pre-surgery goal of learning to scuba dive! One dive left to complete to get my PADI card 🐠
      I was able to go for a 10K/6mile hike in the mountains two days ago just for the fun of it. In the before days, I might have attempted this, but it would have taken me 7 or 8 hours to complete and I would have been exhausted and in pain for the next two days. Taking my time with breaks for snacks and water, I was finished with my wee jaunt in only 4 hours 😎 and really got to enjoy photographing some insects, fungi, and turtles.
      · 1 reply
      1. BabySpoons

        Amazing! Congrats!!! Watch out for the sharks. 🦈

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×