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springchick
make a wish
Member since 5/08 3566 total posts
Name:
justask
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if I reach out pocket Max already do I still pay co pay?
Trying to figure out what do I still pay and don’t have to pay at this point
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Posted 10/11/17 9:09 AM  |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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if I reach out pocket Max already do I still pay co pay?
If you reached the max out of pocket you should not have any further copays for the the year. I reached my son's max OOP after 3 months and have not paid for anything since.
Max out of pocket is different than deductible thought. It is possible to reach your deductible and still have a copay or co insurance depending on the plan.
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| Posted 10/11/17 11:02 AM |
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springchick
make a wish
Member since 5/08 3566 total posts
Name:
justask
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if I reach out pocket Max already do I still pay co pay?
they are still charging me copays and I been max out since july so I am confuse
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| Posted 10/11/17 1:05 PM |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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if I reach out pocket Max already do I still pay co pay?
I would call the insurance company and verify. Some policies have a co insurance after deductible is met, before the max out of pocket. Also see what your EOB from the insurance company says for the visit.
Example, my son has a deductible of 5500 and a max out of pocket of 6500. After 5500 we are billed 20% of the cost until we reach the max out of pocket of 6500. I knew he had reached his max out of pocket and went to fill a script and the pharm tried charging me $350. I raised holy hell. It took 2 weeks to get it straightened out. But eventually it was and we got the meds with no payment.
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| Posted 10/11/17 1:32 PM |
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LSP2005
Bunny kisses are so cute!
Member since 5/05 19461 total posts
Name:
L
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Re: if I reach out pocket Max already do I still pay co pay?
I always had to pay copays even when we had hit the out of pockect max. The years we did were when I delivered and I still had co pays afterwards.
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| Posted 10/11/17 4:49 PM |
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loveus
LIF Adolescent
Member since 9/13 684 total posts
Name:
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if I reach out pocket Max already do I still pay co pay?
I would still need to pay a co-pay. When I look at my insurance statement the total out of pocket total never includes the co-pay.
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| Posted 10/11/17 5:18 PM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: if I reach out pocket Max already do I still pay co pay?
No, once you hit your OOP max, you pay nothing more.
Message edited 10/13/2017 9:56:04 AM.
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| Posted 10/12/17 12:48 PM |
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ave1024
I Took The Wrong Road
Member since 12/07 6153 total posts
Name:
That Led To The Wrong Tendencies
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Re: if I reach out pocket Max already do I still pay co pay?
On my plan, no copays after hit out of pocket max.
Many doctors still insisted on charging copays, claimed that i was always supposed to pay them regardless. I explained to them that under MY plan, they were wrong.
I did look at an Explanation of Benefits for a bill where I didn't pay a co-pay, my insurance paid the provider 100% of their contracted rate. I even had one provider refund a copay (much to their disdain) after I proved to them that they were paid 100% and they were trying to double dip on the copay.
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| Posted 10/12/17 3:13 PM |
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ave1024
I Took The Wrong Road
Member since 12/07 6153 total posts
Name:
That Led To The Wrong Tendencies
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Re: if I reach out pocket Max already do I still pay co pay?
Posted by springchick
they are still charging me copays and I been max out since july so I am confuse
Tell the provider that you hit your out of pocket max and they shouldn't be charging the copay. They should wait until they get their EOB from the provider before billing you for this.
The providers really don't know if you hit your OOP max so they still like to charge copays.
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| Posted 10/12/17 3:14 PM |
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