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That's why the out of pocket maximum exists. (I think?)
by praneshp 7y ago
That's why the out of pocket maximum exists. (I think?)
- jmcqk6 7y agoThe out of pocket maximum can be a lie, too. I have an 'out of pocket maximum' on my ACA insurance plan, but there are medical services that are exempt. Last year, I paid $4000 more than my $6500 out of pocket maximum, because I had a heart procedure and the heart rehab following the procedure was an exception to the out of pocket maximum, a fact I discovered only after incurring the costs. You see, if you clearly follow the asterisk and the footnote references in the policy, then it's very clear that these expenses would not have been covered.
- leetcrew 7y agoif I understand correctly, the out of pocket maximum might only apply to in network providers. I think if you end up getting a non-covered procedure or get service from an out of network provider, you can be on the hook for way more than the out of pocket maximum. if so, it would be hard to ensure that this doesn't happen in an emergency.
- ummonk 7y agoThat was fixed long ago by ACA. Emergency services are treated as in-network regardless of whether they were actually in-network.
- jjeaff 7y agoWell yes, but you make it sound so easy. You'll have to go multiple rounds with the insurance and aca reps in many cases to get it approved after the fact.
- ummonk 7y agoYes, and that is the biggest issue. Hospitals and insurance companies playing hot potato with each other while the hospital tries to pin whatever the insurance company doesn't pay for on the consumer. We need more punitive regulatory action for such situations.