question about PPO insurance deductibles and out of pocket max

I have a BC/BS PPO.  I have a $300 in-network deductible (which I met in January) and a $2500 out of network deductible (none of which I have used).  I also have a $3000 our-of-pocket max per year (i am not sure of EXACTLY where I stand on this, but I have probably met close to $2000 of it).

When my current therapist retires, I would like to see a counselor whom I had seen briefly before (specifically for EMDR), but he is out-of-network (he accepts NO insurance at all... so clients pay him in full at each session and then submit his bill themselves to their insurance company as out-of-network services).

So... my question is whether the out-of-pocket max includes the out-of-network deductible or not.  In other words, if I have already met my $3000 yearly out-of-pocket maximum, would I still have to pay the $2500 to him THIS YEAR (I knwo that I would ahve to pay it NEXT year) or does "out-of-pocket" max mean just that (and I would get the 50% that they cover for out-of-network mental health services without having to pay the first $2500 before the 50% would kick in)?

At $90/session, I'm trying to figure out whether there is any way I can afford to see him or if I have to find someone completely new... and the info I havre from BC/BS is VERY vague.

Lora

Ok so here is my professional advice. I work for a prescription Benefit Manager and work with OOP's everyday and the thing is that it can mean either for your plan. typically the oop does include the deductible like mine deductioble is 4000.00 and oop is 7000.00 but the 4000.00 counts toward the 7000.00. You need to read your coverage very carefully. I would verify that you dont have a plan max and if you can submit claims for reimbursement . If you want to message me that exact wording of you plan I can take a look and see if I can figure it out for you

Hi Lora,

I can't speak for health plans in other states but in MA, where I am a health insurance boker, most insurance carriers do apply both in and out of network deductibles towards your OOP maximum.  However, you should find out what kind of plan deductible you have because some plans run calendar while others run policy year. Most plans do not offer deductible carry over and depending when your deductible year ends, you could find yourself with some unexpected expenses. What carrier do you have and what is the name of your plan? If you would like send me a PM with the info and I will be glad to look into it for you.
 
Rose