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https://imgur.com/a/t7M2RGv https://imgur.com/a/t7M2RGv When I called, I was told that it's there to show that the OOP max for in-network and out-of-network pr
by monktastic1 5y ago
https://imgur.com/a/t7M2RGv https://imgur.com/a/t7M2RGv
When I called, I was told that it's there to show that the OOP max for in-network and out-of-network providers isn't summed to get my total OOP max; instead it's just equal to my OON OOP max. (Of course, this plan makes it hard to go bankrupt, unlike all ACA plans. That was a bit of literary liberty.)
- salawat 5y agoAh... So they're differentiating MOOP levels they'll honor based on the provider in question. I'm guessing they probably have some funneling arrangement that recoups the extra spend they'd incur from the potentially more frequent MOOP attainment in network. Cute, but it really kinda sidesteps the concept of "Max out of pocket". I sense an MBA at work.
- monktastic1 5y agoReplying here because I couldn't respond to your other comment. All the ACA plans I've looked at pay nothing for OON, so in effect there's no maximum I may pay, right? I'm curious about this redlining solution. How do you decide how much you'll pay them?
- salawat 5y agoBasically, you can just piggy-back essentially on your insurer's bargaining power by agreeing to what they would agree to pay +/- a percent on top. The provider can still refuse to provide service to the updated terms of course, but it puts the ball in their court, and insulates you from "surprise" bills. Just blindly signing it means exactly what is on that sheet of paper, that the provider settles on an amount, and you are accepting an obligation to repay it. Redlining and setting a ceiling on what you're willing/able to pay shows good faith. Which if it comes to a court case, goes a long way.
- Tijdreiziger 5y agoExcuse me -- your yearly deductible is $10,000? Here I thought €385 was a lot...
- monktastic1 5y agoNo, the deductible is much lower. This is the maximum I can spend out of pocket in a year. But most ACA ("Obamacare") plans have no maximum for our of network providers.
- salawat 5y agoActuallly... If it is an ACA plan, there has to be a MOOP. https://obamacarefacts.com/health-insurance/out-of-pocket-maximum/ https://obamacarefacts.com/health-insurance/out-of-pocket-ma... Now keep in mind, as mentioned earlier, if you go to an out-of-network provider, and get billed for the balance of what that provider charges and your insurance won't cover, that is now between you and the provider because the insurance claim is technically complete. This is why in some cases you may want to redline the financial responsibility statement and specify you will pay up to a set amount over what your insurer disburses. Technically, the provider can come back and grumble, but if you absolutely cannot afford to get nailed with a notorious "surprise" medical bill, that's a much more "good faith" way to approach the transaction. It sucks... I know.
- akomtu 5y agoYou probably pay way more in taxes. If I was given a choice between (1) an additional 20% income tax and free healthcare, or (2) crazy $10k/year out of pocket maximum, I'll choose 2 without a blink.
- Tijdreiziger 5y agoAt the risk of turning this into a political debate -- yes, you pay more taxes if you earn more, and less taxes if you earn less. That's how a society is supposed to work: you don't leave people to suffer because they aren't rich.
- jackthetab 5y ago> (Of course, this plan makes it hard to go bankrupt, unlike all ACA plans. Can you elaborate on this? I'm currently looking into ACA plans and would rather not go bankrupt...