Co-Pay and Out of Pocket Maximum Questions
Hello all, I've recently had a medical diagnosis that has required a lot of medical care. With this, my out of pocket maximum has already technically been reached with the co-pays that I have done, but these claims have not yet been sent to the insurer. Here's the numbers as the insurance understands them.
Out of Pocket Maximum: $3,000
Current OOPM for Me: $1,200
I have another 4 charges that equal about $1,900 total in terms of co-pay, meaning I've already overpayed for the OOPM for the plan. However, the place I'm at still has charges for co-pay for additional treatments ($300 daily). I've spoken to the clinic as well as the insurance, and both sides say simply not to pay the additional co-pays as of now.
Does this all sound correct? I have received an okay from both sides so I think I'm okay to just wait for those claims to go through. Or should I try to manually make said claim with my insurance? Just wondering if anyone has any advice here.
submitted by /u/meatwad819
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