Highmark’s "Total" Out of Pocket Max

My spouse’s employer switched insurance companies this year and last year we chose our 2023 plan based on the limited information his employer gave us about the plans. The plan we chose had a $2000 deductible and a $2500 OOPM, according to the information provided.

When we received our cards in January I noticed a line that read “TMOOP $7150” on the cards, below the OOP and deductible information. Not being familiar with a “total” out of pocket, I assumed this must be for out of network coverage and didn’t worry about it.

Well, lo’ and behold, we’re getting medical bills far exceeding $2500 for the year, so I looked into it. Turns out the “out of pocket max” for this plan is total BS, does not include our $2000 deductible, and does not include co-pays. So, we have to pay $4500 before we stop paying coinsurance and then we keep paying co-pays and “services that may not be covered” until we hit $7150.

I’m so angry and frustrated. I’m almost 40 years old and now they get to change the definition of “out of pocket max” all of a sudden? They can just do that? OF COURSE, it’s all my fault and I should have researched the plan I was buying before I bought it. Obviously, this must be legal or they wouldn’t be doing it. Nevermind that it’s impossible to get more than basic deductible, OOPM, and co-pay information before you choose a plan; internet research is impossible because every insurance company has 200 plans available all called the same thing. But yeah, my responsibility to know better!

I am going through cancer treatment and already feel guilty about how much this has cost my family, all the time I’ve had to miss at work, and all the money we’ve spent. And now it looks like we’re going to pay three times as much this year for medical bills!