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So I have a member who has a copay but states they have met their OOP for 9-2018 but the DOS is 12/11/18? Would they still be responsible for the copay even though they met their oop prior to the DOS?

  • It depends on the plan. The ACA requires that all member out of pocket costs (for covered services) accrue to the OOP max. So almost all plans will accrue all costs, including copays, to OOP max. You should probably ask this person's insurer though. – quid Feb 4 '19 at 19:41
  • What are OOP and DOS? (I know what they are as programming & operating system acronyms, but I’m unfamiliar with them as financial acronyms.) – Lawrence Feb 5 '19 at 2:20

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