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Out Of Pocket Max



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I had my surgery on December 12. The claim for my hospital stay has been pending since that date and I've been waiting for the ultimate bill. My insurance stands that it pays 80% and I pay 20% up until my out-of-pocket max is met (which is $5,000.) After that, the rest is covered. I have a general idea what my bill will be and that's fine.

The question is that it is now near the end of the year and soon my insurance will roll over and I will stand at $5,000 out of pocket maximum (throughout the year I've been working on reducing it.) Since the surgery was in 2018, will they be basing the amount I owed on what out-of-pocket deductible that I have left in 2018? Or will I have to deal with the brand new, never been touched, $5,000 of 2019. I was really hoping that the final bill would have been settled, but alas I'm still waiting.

TIA, sorry for the weird question!

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22 minutes ago, notmyname said:

It will be based on the 2018 amount

Thank you! I know it was a strange question, but I just needed some reassurance. :)

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What insurance do you have? Mine is Aetna and I will have to the %80 %20. I’m a little nervous what I will have to pay.

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