0

I believe i have an Anthem PPO 250 plan. One type of service only mentions a $1000.00 daily cap on rendered services. The only other mention of my responsibilities is a 30% copay for services out side of network. However, on my claim, it seems like they applied this 30/70 up to a certain amount ($100).

Is the "maximum allowed amount" something that supersedes the actual plan? Should i see mentions of it in my benefits hand book?

1

If you are already covered by this plan then details for your specific plan must be available on the insurance company website, to make sure you are seeing the correct information you should only be looking at documents that you can see after you have logged into the website.

The plan documents should also include examples explain how the different limits apply.

For your specific claim there will be an EOB (Explanation of Benefit) that will walk you though how the charges for the different services on that claim are covered by your policy. It will also take into account the network status of the provider; the category of the service; and how your deductible, co-pay and co-insurance rules apply to that specific claim.

If the EOB doesn't answer your question, call the toll-free number to ask questions. There is also a chance that something was miss-coded.

It is possible that the policy documents are also on your employers website, but I found that if there were multiple choices involved, the most accurate and relevant set of documents is on the insurance company website linked to my account.

Your Answer

By clicking "Post Your Answer", you acknowledge that you have read our updated terms of service, privacy policy and cookie policy, and that your continued use of the website is subject to these policies.

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