Out of Network - Maximum Limits?!?!

Hi Everyone...

I have Carefirst (BCBS of MD/DC/VA) and I am going to go to Dr. Greenbaum in NJ and I believe he is out of network... my plan states that if the doctor is out of network they will pay 80% and I will have to pay 20% but then it says something about a maximum out of pocket expense of $1500 (to protect members from catastrophic illnesses, etc.)... so does this mean that I will only have to pay $1500 despite what the 20% is?

I'm sooo confused! Any help would be appreciated.

Thanks!

Lori 

There is usually one "out of pocket" limit for in network vs. out of network. Is the $1500 for out of network or in network?

$1500 is for out of network - I don't have an annual deductible or max out of pocket for in network because they cover that 100%.

My plan is really weird... there are 3 tiers of coverage.

1st - BlueChoice HMO - covers 100%

2nd - Preferred Provider Option PPO - covers 90% with a $300 annual deductible and $1,000 out of pocket maximum.

3rd - Indemnity - covers 80% with a $600 annual deductible and $1,500 out of pocket maximum.

I called them today and they told me ask if Dr. Greenbaum is a BlueChoice HMO provider because that would give me the most benefits (duh!).  The rep looked online and she said that it looks like he is, but I emailed his office to verify.

If he is out of network and they only pay 80% will I have to pay him the rest of the 20% plus my $1,500? 

Thanks!

Lori