Does paying for a nonelective procedure (biopsy) with cash count toward the maximum out-of-pocket limit?
Hi everyone, I`m a 23-year-old male living in California and I have a PPO through my college. 4 years ago I had a cyst/tumor in my jaw and it was removed 3 years ago (it got delayed because of COVID lockdowns). 3 weeks ago I went to my doctor and it turns out it came back. They told me I needed to wait for my insurance to authorize the biopsy they said it would take about a week but it took longer, I was calling them every couple of days to follow up on the authorization, and by the end of the third week they told me that it would be the $150 deductible + 20% of the cost of the biopsy, and an extra $5,000 deductable for a pre-existing condition (my college switched insurance providers about 2 years ago). My maximum out-of-pocket cost is $6,000, but the issue is I`m transferring to a 4-year university next semester which means my insurance provider is also changing. So does anyone know if I pay for the full cost of the biopsy, would it count towards the $6,000 limit? My concern right now is if I pay the $5k for the pre-existing deductible and the surgery is scheduled till after I transfer and change insurance I would have to pay another pre-existing deductible for the surgery, and I just can`t afford that. So any feedback or advice would be greatly appreciated.
(I`m here on a student visa so I`m not eligible for Medicare or any other government assistance)
submitted by /u/No-Sheepherder4309
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