Question:
Has anyone encountered the out-of-pocket maximum situation before?

I'm normally covered by a PPO, but I'm having the surgery in Montana where they don't have PPO coverage, so theoretically my coverage is 80%. But I also have a stipulation in my plan that says I have an "Out of pocket Maximum" of $1500 per year. If it's 80% of $20,000 I'll still owe $4000. If this out of pocket max is correct, only another $1100 or so. Has anyone else had the same thing in their insurance plan, and if so, what did you have to pay? Thanks so much!    — Luci L. (posted on July 21, 2000)

July 21, 2000
I have an 80/20 plan with an $750 out of pocket max. So that is the max of what I will pay no matter what it costs.
   — ZZ S.

July 22, 2000
My out of pocket maximum is $1500...my understanding is that, plus any unpaid deductibles, is all I should have to pay. However, why not do this: your doctor is making $40-50k from this surgery. Ask him to waive it, especially if you are certain he does self-pay at reduced rates.
   — Allie B.

July 22, 2000
Yes! Isn't it nice to have a feature of health insurance that actually works FOR us. My out of pocket maximum is $500. I have easily met that in the first few months of this current policy year, so my surgery (7/13) is absolutely free for me. The only medical expense that is not covered under my out-of-pocket maximum is prescriptions. I wish you great success with your surgery! Kathy
   — Kathy M.