Insurance Question
Hey guys, it’s my first time posting in here. I’m getting an mri soon and I’m trying to understand my health insurance plan. When I read my coverage this is what it says under deductible schedule:
The following deductibles are to be paid by the Insured in addition to the Insured Coinsurance Percentage before any Specified Disease Benefits are payable by Us for Covered Expenses: A. Calendar Year Deductible per Insured: $5,000 B. Failure to Pre-Certify Treatment Deductible: $1,000 C. Separate Deductible For Non-Participating Providers: $5,000
And this is what it reads under co insurance
For Participating Providers, after satisfaction of all applicable deductibles, the following Company Insurance Percentage, Insured Coinsurance Percentage, and Insured Maximum Participating Provider Coinsurance Payment, apply to all Covered Expenses in a Calendar Year: A. Company Insurance Percentage: 80% B. Insured Coinsurance Percentage: 20% C. Insured Maximum Participating Provider Coinsurance Payment: $2,000
I’m trying to figure out what my out of pocket maximum would be. It’s confusing because the deductible is higher than the out of pocket max. Can someone help me understand?