Help dealing with how to take advantage of my out-of-network out-of-pocket maximum w/ Blue Shield PPO

Hi, and thanks in advance.

I have a Blue Shield PPO that has a $6500 deductible for out-of-network and a $20k out-of-pocket out-of-network max. I had some out-of-network surgery that I got approved (as out of network) before surgery. I just got a bill from the surgeon for $45k. I'm confused as to how to handle this so that I don't pay more than the $20k out-of-network out-of-pocket max. I called Blue Shield and got an answer advising me to write the surgeon a check for exactly the sum of the out-of-network max of $20k plus the $6500 deductible, and then have the surgeon resubmit to the insurance company, who will pay the rest. This doesn't fit with my understanding of deductibles, and also doesn't fit with what Blue Shield's own website says about what out-of-pocket maximums mean. Further, I called my surgeon (it's actually Stanford Healthcare, so it's a large org with its own billing department) and they agreed that the answer made no sense.

Does anyone have any idea how to handle this on my end? Do I write a check for $45k(!) to Stanford, and then submit a claim to Blue Shield and hope they pay the difference between the bill and my out-of-network out-of-pocket max of $20k? Something else?

Thanks!

submitted by /u/doctor-yes
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