I am super confused about my insurance.

Hi, this is the first time I have ever had health insurance that wasn’t Medicare and I currently have a HDHP though my job. My annual out of pocket max is $5,000 and this year I had some unexpected healthcare costs for two small surgeries so I have currently met $3,600 according to my health care provider Cigna.

However I have an outstanding balance of $3000 with the doctors office where I received my treatment and am currently paying this off monthly. I was under the impression that if I made a payment of $1,400 I would then have reached my out of pocket max of $5,000. So then Cigna would cover the rest. However seems like I was mistaken as I just spoke with someone from the insurance company who said that this would not count as my out of pocket as the amount has already been applied to my account.

The thing that confuses me is I will end up paying over $5,000 “out of pocket” this year for medical expenses (all in network). So if I was to clear me balance today with this doctors office I would have paid $6,600 to date. This exceeds my annual out of pocket max by $1,600. So shouldn’t Cigna be covering that $1,600? Sorry…I am so damn confused about this. Can somebody please help me understand this? If I thought Cigna would cover this remaining balance over 5k then I would happy make a large payment today so that I can avoid having to pay more in the long term.

Thanks!!!

submitted by /u/InternetMedium4325
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