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Weird insurance question!

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This confuses me because my deductible is a $1000 and out of pocket max is $3500. I know I have to pay something upfront just don't know if it will be $1000 or the $3500.

This confuses me because my deductible is a $1000 and out of pocket max is $3500. I know I have to pay something upfront just don't know if it will be $1000 or the $3500.


So your deductible has to be met before the insurance will pay, so that for sure needs to be met prior to surgery (most doctors work this way). This is where it depends on the individual surgeon on what they require. Let's say, after your deductible, you are responsible for 20% and the insurance covers the other 80%. The max out of your pocket would be $3500 before the insurance covers your surgery 100%. Some offices make you pay the max out of pocket and some bill you after. Just call and ask so they can tell you a for sure amount.


17 minutes ago, Mandybb said:


So your deductible has to be met before the insurance will pay, so that for sure needs to be met prior to surgery (most doctors work this way). This is where it depends on the individual surgeon on what they require. Let's say, after your deductible, you are responsible for 20% and the insurance covers the other 80%. The max out of your pocket would be $3500 before the insurance covers your surgery 100%. Some offices make you pay the max out of pocket and some bill you after. Just call and ask so they can tell you a for sure amount.

I went to my appointment today I asked and she said I can let you know closer to surgery. I know I will have to pay upfront but I got confused because the one nurse kept saying the deductible but then she said I'm not the insurance guru.

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