1. Individual had Medical Plan with Deductible of $1300.
  2. Deductible was met within a few months of start of calendar year.
  3. Plan is on calendar year.
  4. Mid-year Individual changed plan within the same company to a Family Plan.
  5. The new deductible is $3000 and $1300 from prior plan was transferred ( the new plan started with $1300 met for the deductible)
  6. Both plans have the same co-insurance percentage.

The medical expenses that led to the deductible being met under the first plan were enough to have met the deductible under the second plan but only the portion initially applied to the deductible was transferred as deductible; anything above the deductible was either covered or paid as co-insurance.

Is it possible to ask the insurance to recalculate the medical expenses during the calendar year as if they had happened under the second plan so that the deductible is met as well?

  • for the family plan is it one deductible for the family or are there also individual deductibles? – mhoran_psprep Oct 20 '18 at 11:51
  • No individual deductible for family. – d0001 Oct 20 '18 at 12:03
  • you may need to include numbers. You paid 1300, then you paid x% of the next Y in bills. – mhoran_psprep Oct 20 '18 at 12:24
  • So you want to pay $1700 just for the sake of having met the deductible ? – xyious Oct 22 '18 at 18:01

Who cares whether it is possible? It is not advantageous.

The reason you've only got $1300 toward deductible is because you received benefits after reaching that point under the first plan. Returning those benefits in order to reach the new deductible more quickly would be pointless.

In the end, you'll have $3000 of deductible, and (X-$3000) to which benefits applied. The fact that those occurred out of the usual order (as $1300, Y-$1300, $3000-$1300, X-Y+$1300-$3000) doesn't affect much of anything.

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