3

I hit my 2019 out of pocket max after a surgery in Nov 2019 but am still getting bills related to it (e.g. anesthesia). Since I’ve hit my max, I shouldn’t have to pay these. What am I supposed to do? Thanks!

  • 4
    Talk to your insurance company. Maybe you need to directly file claims with them instead of the doctors filing for you. Or they're charging you for things not covered by the insurance plan. – RonJohn Jan 4 at 23:03
  • 1
    I made sure everything I had done is covered. I feel like I hit my out of pocket max while the new bills were in process. I feel like it’s very unfair if I have to pay them. – Samathaw Jan 5 at 4:01
  • And that's why you need to dig out all the EOBs and talk to the insurance company. Ask if those charges have been submitted. If they have, then wait for the EOB and see what it says. If the doctors haven't submitted the claims, call them up and ask why. – RonJohn Jan 5 at 4:37
  • 1
    anesthesiologists tend to be out-of-network. Have you met that out-of-pocket max yet? – mkennedy Jan 5 at 20:20
3

Medical billing is a nightmare.

Bills for major medical events can trickle in for months. In some cases they go directly to the insurance company and the only evidence you see is in the EOB (Explanation of Benefits). Other times you will be the middleman, they expect you to submit bills to the insurance company. Some of thee are in-network, some or out-of-network. Sometimes you will see a bill months later because the insurance company is slow to pay, so the provider wants to get you involved.

I will give an example. A few years ago the county ambulance was called. They have a fee, but only if your insurance company will pay it. So the county bills you, you submit it to the insurance company and they get their money; but if the insurance company rejects the bill you send the notice back to the county and they never ask again.

Remember that the medical provider has no idea if you are below, near, or above your deductible or how your out-of-pocket maximum compares to your situation.

| improve this answer | |
  • 1
    That's a good county. Here they bill you for the balance your insurance would not pay. – Eric Jan 5 at 17:52

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.