Deductible??Out of Pocket??

What exactly does it all mean.  I know that I have a $500 deductible so I have to meet that before the insurance company will pay.  But then I have a $2500 out of pocket and 80/20 coverage on my surgery.  So I am right to assume that no matter how much the surgery costs, my maximum that I should have to pay is $ 2500 + $500= $3000?? ALso, does the 80/20 ususally cover all the pre op testing and all the hospital and hospital doctor fees? Somebody straighten me out!! Linda

Thanks Paul! Linda

The deductible is what you would meet before insurance pays for anything.  Deductible does not apply to office visits if you have a standard copay.  The 80/20 means  the insurance pays 80% of the allowable if its in the network.  For instance,  if the anesthesiologist bills 800.00 the insurance may only allow 600.00 the 200.00 would be the discount that is written off by the provider and insurance would pay 80% of the allowable (600) not 80% of the billed charges.  In this instance if your ded was met you would be responsible for 120.00.

You can also check with your insurance provider to see if you have a "maximum out of pocket expense".  My maximum expense is $2000.  Regardless of how much my insurance covers, the most  I would have to pay in any given year is $2500.

One thing you need to remember and be careful of is that if a service (like the psych eval) is NOT covered by your health insurance then that charge does NOT get applied towards your maximum out of pocket. Our insurance does not cover dietary counseling unless you are pre/diabetic, so I will have to pay for that out of pocket and it will not be applied towards the maximum. Another thing to look at is whether or not the office you are visiting is a participating provider for your insurance company, otherwise they do not write off what is not allowed and you can be billed for that by the office and it will not be applied towards the maximum out of pocket.