Insurance rep says 100% will be covered after deductible is met, but I am still worried

Hello,

I will be undergoing an expensive surgery with an out of network provider soon. My deductible for out of network is rather high (10k+), but the surgery is expensive enough that this will still cut the cost considerably. I was told over the phone that once my deductible is met, they will cover 100% of out of network costs. I even gave them an example, asking "if the surgery costs 40k, you guys would cover 30k?". The person over the phone confirmed this.

However, my doctor's office is under a different impression. They believe that the insurance will only pay the 'max allowable' rate for each surgical code. I tried asking for these rates from my insurance, but was not told them. They did give me in-network rates, though, which add up to considerably less than the the 30k they'd be paying after the deductible, supposedly.

So my question: Is it true that my insurance will pay 100% of the cost after my out of pocket deductible is met, rather than the 'max allowable rate' for each surgery? Also note that my copay after my deductible is 0%.

Here's the plan details: https://www.anthem.com/docs/public/inline/PERS_Platinum_2022SOB.pdf

Really appreciate any help!

submitted by /u/Civil_Difference_476
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