Trying to plan finances - is deductible considered part of max out of pocket?

MEZ
on 12/2/11 1:07 am, edited 12/2/11 1:37 am - Wilmington, NC
Is your deductible considered part of your max out of pocket?

Anyone know?

I have BCBS but would assume it doesn't really vary.

So, for instance, if I have a $1000 deductible, and $3000 coinsurance, but max out of pocket is $3000... does the deductible count towards that? Hospital financial person is telling me it doesn't.

Thank you! TGIF!

Ellen            RNY      Surgery Date: 12/6/2011
5' 5.5"          Surgery BMI 37.5        HW 254            SW 230         GW 150 - reached 11/6/12 

    

sknd34
on 12/2/11 1:37 am - West Fargo, ND
Yes, your deductible is considered part of your max out or pocket.
Jennifer M.
on 12/2/11 3:02 am - Casper, WY
Plans may be different. My deductible did not count towards my max out of pocket.
DebsGiz
on 12/2/11 8:48 am - FL
Jennifer,

I think I would protest that with your insurance carrier.  A deductible is most certainly and out-of-pocket expense and should be counted towards the max out of pocket I would think.

LindaScrip
on 12/2/11 4:37 am
I would call my insurance co and ask.
stacezoe
on 12/2/11 5:22 am
I work in Insurance, have had several clients one of them being BCBS and deductible was always included in OOP.

I have Untied insurae with a high deductible (2400) and it was applied to my oop max, so once i paid my ded I was done for the year...Look into HSA or FSA you can contribute pre tax dollars to these accounts so its not such a shock when its time to pay for your surgery!
 Inspiration move me brightly...Grateful Dead Terapin Station
  HW 286 SW 279 CW 231 40y/o 5'10  Month 1-17, 2-7#, 3- 7#, 4-3#,5-3#      
Becky D.
on 12/2/11 1:11 pm - CA
 Your deductible does count towards your max out of pocket. 
Co-pays for follow up visits do not. 
loretta cowels
on 12/2/11 8:01 pm - MI
RNY on 04/16/12
i have bcbs to and if your deductible is met for the year. All you should have to worry about is your doctors visit copays. If you call the number on the back of the card they are pretty good at telling you what they will cover.
Jackie McGee
on 12/3/11 12:21 am - PA
I do insurance daily, and here's my understanding of it:

If you have a $1,000 deductible, 100% co-insurance and a $3,000 OOP max it should work like this:

Once you meet your $1,000 deductible, you'll be covered at 100% (after a co-pay, if you have one, or with no co-pay if you don't have one) - and once your $1,000 deductible is met, since you paid that OOP, you'll have a $2,000 OOP remaining.

Honestly, that's not a bad policy at all. I've seen way worse.

 Proud mama of Mischa and Gabriel, both born post-op.

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