"Slow Pay, Low Pay or No Pay": Blue Cross Approved Surgeries Then Refused to Pay

Noteable here: Out of network. What did she expect to happen?

My insurance has a separate deductible and max out-of-pocket for out-of-network providers.

When I reach those, I’d expect them to pay the remainder. As agreed. As implied by a prior authorization.

No sane healthcare system that puts ordinary citizens first should ever have this distinction.

> When I reach those, I’d expect them to pay the remainder.

They won't. "Out of pocket maximum" means something completely different to the insurance company than it does to any normal person.

Out of every dollar you pay out of pocket, the insurance company will decide how much they feel like counting it. Might be the full dollar, or some pennies, or nothing.

You might have paid $20K out of pocket in a year, but the insurance company will say you've only paid $1000 because just because. Good luck reaching that "out of pocket maximum".

Source: I've been there.

I reach my out-of-pocket maximum, every year. The rest of the year, we pay no more copays.

I've never seen a max out of pocket for out of network.

You have now! https://imgur.com/a/Qw62Vhl

That's via Aetna.