paying what insurance doesnt

I've been lurking in the message boards for a while, and I don't have a full answer to my own question yet.  I have done the 3 month program required by my insurance company, and my paperwork was faxed to insurance about a week ago and I'm still waiting for approval.  Now on to the next question....trying to figure out what I'm going to pay! 

So my new plan year with insurance just started over June 1st.  I know my deductible max out of pocket is $1200.  Soooo, with that being said, what else may I have to pay?  I've never had to use my insurance for something this big, so I'm confused about the difference between a deductible, and how insurance pays 80% and I pay 20% normally.  Does this mean I should just pay for the deductible, or does it mean that I pay the hospital/surgeon the deductible, and then I still owe 20% of the surgery related fees on top of that? 

Sorry if this has been asked and I just missed it.  Any info would be great.  I'm kind of freaking out right now because I have no idea how I'm going to finance this if it is more than my deductible!! :(

That 20% difference is called coinsurance.  Generally a group plan will have a cap on that.

Let's say your surgeon's fee is $11000.00.  Your insurance company allows $8500.00.  If you have not met any of your deductible or coinsurance, the $1200.00 deductible would be subtracted from the $8500.00, leaving $7300.00.  Your insurance company would pay 80% of the $7300.00, or $5840.00.  You would owe the $1200.00 deductible and the $1460.00 coinsurance, the 20% of the $7300.00, for a total of $2666.00.

Of course, there are a lot of factors that I don't know.  Have any other claims been submitted and had deductible applied?  Does that $1200.00 include coinsurance?  If not, what is your plan's coinsurance limit?  (That $1460.00 would get applied to it.  When you meet the limit, normally the plan pays at a higher percentage of the allowed amount.)

This is where you need to speak with someone in HR or your insurance company customer service rep, but that's the basic idea.  Good luck!

Wow, THANKS!  That helped me get a much better understanding.  I'm going to call insurance again tomorrow...seems like no one ever understands what I'm asking when I call...maybe it is just me not asking correctly! :)  I'm very appreciative of you answering me as best as possible so fast..I'm so impressed with all the members of this site so far! 

The way I asked is "How much am I going to have to pay total out of pocket?".. if you word it that way you should be able to get a pretty decisive answer.