How do insurance companies track how much you paid towards your Deductible and Out-of-Pocket limits? — And when are these limits deemed as being met?

Question 1 –> First of all, how would they know whether you actually paid every bill or not? …. (doctor's bill, labs, etc..) …. Does each medical office inform the insurance company when you have PAID their bill? Is that how the insurance company knows?

I am asking because I am trying to understand to know how you deal with bills when you have almost reached your Out-of-Pocket maximum.

For example —- if your Out-of-Pocket maximum is $8000 for the year, and let's say you have already spent $7900 this year. Now let's say you have a couple of new bills that are yet to be paid – one is $500, another is $100.

Question 2 –> would you need to pay both the $500 and the $100 bills because they were both generated while you are still at $7900 and not at $8000?

Question 3 –> what if you pay the $100 bill and so now that makes you meet your $8000 limit — now can you get the $500 to be re-done since you have now met the $8000 out-of-pocket maximum?

Thanks.

submitted by /u/boball
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