Post by 2peafaithful on Jun 27, 2014 12:34:29 GMT
We have insurance through my dh's employer. It has always been very good insurance. There were a few minor changes in the policy this year. I don't have a list of what they are here but they were relatively minor and we still have very good coverage. A few weeks ago when I went to pick up a routine script they said there is no copay for it. I was surprised and told my dh about it. He called and they said we had met our out of pocket max for the family and wouldn't have to pay anything as long as it was in-network the rest of the year. That was a new change to the year for sure and one we hadn't noticed from reading. We haven't had anything huge and major this year but the max for family is $1000. We have paid that out though just added up quicker than we realized. We have more medical than the average family for sure and so for us $1000 by June wasn't a lot out of pocket for medical.
I have to go to a PT occasionally for a flare up and started going this week. The office person said we will verify your coverage and let you know. I told her about the no out of pocket and she said we will verify and let you know. She called me yesterday and said you do have a $25 copay for your specialist copay and 60 visits per calendar year. I told her that was different than I had been told. I called my insurance provider and inquired and the person that pulled it up said, that is correct you don't have any more out of pocket. I told her was the PT office had stated and she said if you hang on I call them on the other line. She called and the insurance person wasn't there but left her a message and told her she could see how it would be an easy oversight but that indeed we didn't have any out of pocket.
I went to my appt yesterday and she said you don't have a copay today. We briefly spoke about the insurance company calling them and she said yeah we will need to check on it again because we had never seen that.
Does anyone have experience or a policy that has a pretty out of pocket max and than no expenses after that if it is in-network? I could tell from her tone that she didn't think it was accurate (the office person) and because this is new to our policy I was surprised too. No complaints but if I don't have to pay $25 (specialist) and $15 for primary than great. When I have to go to the PT it might be for 2-6 weeks and 2-3 times a week so it really adds up. My dh said maybe you still have your co-pays and I told him I asked about that and the insurance company said that NO more out of pocket for in network meant that we wouldn't have a payment of any kind.
I have to go to a PT occasionally for a flare up and started going this week. The office person said we will verify your coverage and let you know. I told her about the no out of pocket and she said we will verify and let you know. She called me yesterday and said you do have a $25 copay for your specialist copay and 60 visits per calendar year. I told her that was different than I had been told. I called my insurance provider and inquired and the person that pulled it up said, that is correct you don't have any more out of pocket. I told her was the PT office had stated and she said if you hang on I call them on the other line. She called and the insurance person wasn't there but left her a message and told her she could see how it would be an easy oversight but that indeed we didn't have any out of pocket.
I went to my appt yesterday and she said you don't have a copay today. We briefly spoke about the insurance company calling them and she said yeah we will need to check on it again because we had never seen that.
Does anyone have experience or a policy that has a pretty out of pocket max and than no expenses after that if it is in-network? I could tell from her tone that she didn't think it was accurate (the office person) and because this is new to our policy I was surprised too. No complaints but if I don't have to pay $25 (specialist) and $15 for primary than great. When I have to go to the PT it might be for 2-6 weeks and 2-3 times a week so it really adds up. My dh said maybe you still have your co-pays and I told him I asked about that and the insurance company said that NO more out of pocket for in network meant that we wouldn't have a payment of any kind.
His insurance has always been amazing and we are grateful. When my ds had $500,000 a couple years ago but numerous times of PT since then we didn't have to pay anything. He has medicaid due to a waiver program (based on disability not income) but in our state legally if you have a private insurance it has to be primary so our private covered it all. 
