The "usual and customary" fee for the test was let's say $750. The Insurance negotiated rate is $500, which was paid.
The testing facility is coming after me for the remaining $250. That's wrong. They negotiated the rates with the insurance company and I've met my max out of pocket deductible.
Up to this year, my understanding has always been once I've met my max out of pocket deductible, I'm "done." The negotiated rates between the insurnace plan and the doctors that accept those insurance plans are what they get paid (minus any deductible I have left, which is $0.) There's something going on here that I'm not quite understanding, and typically I'm not a dumb guy. I don't think this is right.
The numbers I used above aren't the real numbers (those are significantly higher ..) and not knowing what I'll have to pay to repair the AC Joint in my left shoulder (it's completely separated and painful to reach across my chest or push from any direction) means I'm not going to do it until I know what it's going to cost.
“.) There’s something going on here that I’m not quite understanding, and typically I’m not a dumb guy”
“Insurance” (investment) Lobby = Congress, Mitch Nancy and the RICO.
Two things. Deductibles max out for a given uear. Copays may (if you really have a max out of pocket provision) but also may not (if you don’t).
You EOB (Explanation of Benefits) from your insurance company is the “source of truth”.
If it says you don’t owe an in network provider anything but they are still coming after you then you’re on very solid ground in fighting it.