Ash UK/US

I asked this question on a onther persons thread and no one replied, maybe I will have better luck here.

My insurance is 80/20 covered and has limit of $1750 max out of pocket.

Beginning of Aug I was very ill and had to go the ER, I ended up spending a week in the hospital, had surgery and 2 endoscopies. I also have to have a third one in a couple of weeks.

So I am in doubt that I will be meeting the $1750 limit.

My question is, will all the co-pays (encounter fees) I have paid on doctor visits count towards the $1750 or are those in addtion to the max out of pocket?

Manc

is that per year? or per occurence?

the 2 surgeries may be counted as 2 separate events.
depends on your plan.


hope you're on the mend Ash... sounds like you had a bit of a time of it.

Ash UK/US

Sorry I should have said the out of pocket max is per year.

Duncan Roberts

It will be policy specific. On mine the copays for drugs go towards my out of pocket max, not sure about the services though. Oh, I should add that the best way to find out is to talk to your insurance company. They have the details of their overall policies and then any employer variations.

Mummy in the foothills

For us all doctor visits co-pays counts but it depends on your plan. I'd call and ask.
So if anyone needs stuff done you've got till Dec 31st and it all starts over again.

Ash UK/US

Thanks for the replies. I guess I need to call and find out. I know the ER had a $100 co-pay and the rest have all been $25 so it will probably on be about $300 but ya know $300 is $300!

snowbunny

Depending on your total out-of-pocket for the year and your income you may be able to write off the expenses on your federal taxes. Every bit helps.

Duncan Roberts

Check into that. ER copays are always high to discourage people using them for primary care. However, every policy I've ever seen has a "get out" clause where the copay gets refunded if you are admitted and classed as in-patient. Usually that is based on some sort of time in hospital, my policy is more than 24 hours after being admitted to the ER. That's why if you go to the ER you should never pay the copay up front when you are there, always ask to be billed. They can't force you to pay it up front and by not doing so, should you find you are exempt from the co-pay you don't have to wait for the hospital to refund it.

blondiern

I am not an Expat, but am an American (NJ) RN and would like to offer some thoughts, which, sadly make be more confusing for you in the end...if you have a 'traditional' 80/20 plan, your co-pays should all count towards your deductible...keep in mind, tho, that the 80 percent that the ins co pays only includes what is included as 'covered' costs...so if you have a test/procedure/treatment, etc, that is excluded on your plan, you will bear that cost as well, unfortunately...it all depends on what 'menu' of services your plan includes...traditional plans generally are more inclusive than HMO's, which can be restrictive as to what tests, treatments, etc you have access to, and/or where or who you receive those services from....hope this helps in some way....Ann

Ash UK/US

My policy says that if you are admitted from the ER than the $100 is waived however I went to the ER at 8am and they discharged me with a prescrib for pain med. The pain med did not work so I called my doc and the gave a prescrib for a different pain med. That also did not work later in the day I called my doc again and was told to go back to the hospital. I was admitted the same day, 12 hours after my visit to the ER. I guessing I will be paying the $100 co-pay.

Ash UK/US

So far everything has been covered. Finger crossed the rest will be too.