Surgery cost after meeting OOP maximum
My mom has the “MyBlue individual HMO” plan from Florida Blue. Her plan has a $8,500 deductible, $8,700 out of pocket maximum and 50% coinsurance. She was recently admitted to the hospital due to a bad kidney infection. She was admitted for 3 days to treat the infection and between all tests and doctors visits she just met her deductible and out of pocket maximum. The specialist who saw her at the hospital set up a follow up to schedule a surgery to break down the stone. At his office, we were told he wanted to do the surgery at a surgery center. As they are giving me the instructions, I am told they will call me a few days before the surgery to collect payment for the surgery. At this point I didn’t know my mom had already met her OOP and asked the finance lady how much would the surgery cost. She told me most likely it would be $8700. When I told her she will probably meet her OOP from the recent hospitalization, she said the hospitals usually take a long time to submit claims and they needed to get paid before the surgery which is schedule in 2 weeks. I just double checked with Florida Blue and OOP maximum has been met. What do you guys think about this situation?
