Question:
When do I pay out of network?

Even though Ive been fighting for approval for over a year a half, I finally got approved, But I do have some questions about how the insurance works. I have a $200 In-Network deductible and a $400 Out of Network, So I understand I'll have to pay that, but If I Go in-Network my out of pocket cost Maximum for the year is $1,500.00 and If I go outta Network its $3,000.00. Ok my question is this, Do I have to pay that amount before I have surgery, Or Do I have to have it After, Or can I make payments??How do they decide who gets the money? Im worried because right now, we have alot of medical bills that I am paying for,since last year, when my youngest daughter needed surgery. And it would be really hard at the beginning of a new year to come up with $1,500 not to mention $3,000. Im not sure how all this works so any help would be appreciated to calm my fears of huge medical bills.....    — Ann A. (posted on January 4, 2001)

January 4, 2001
According to Doctor Scotts office here in Missouri they ask for the full out of pocket expence up front. I would say start putting your penny's back, haven't had any luck finding someone that will take payments on the out of pocket expence. To many people lined up to have this done to mess with payments I guess.
   — richter454

January 4, 2001
This is very dependent on your surgeon and hospital and how they handle it. In my case, I went out of network for my surgeon, so I had a 3000 out-of-pocket maximum to meet for the year. My hospital/doctor do all their billing together. They called my insurance company, and found out I would have to pay 3000 out of pocket. They wrote this down and made me sign a paper agreeing to pay that portion. But, I didn't have to pay it upfront. I had my surgery, then the bills started going to my insurance company. After my insurance had responded to each bill, the hospital billed me for the unpaid portion. The hospital also offered to set up a payment plan for me if I couldn't pay the bill all at once.
   — Lynn K.