Out of pocket maximum doesn’t mean what it says (Blue Shield CA)

Hi all, I'm on the most expensive plan my employer offers with Blue Shield CA (Full PPO Combined Deductible 10-250 90/70). I have been seeing an out of network therapist that charges $235 per session. I get reimbursed 70% of the allowable amount – $62 per session.

I was assuming that the rest I paid ($173 per session) was counting towards my out of pocket maximums, and that soon I was going to be approaching the time where my out-of-network out-of-pocket maximum for the year ($3250) would be reached.

Today I called Blue Shield to ask why my out-of-pocket totals were so much lower than what I had actually paid. I found out that only $25 of the $173 I was paying for each session was counting toward my out-of-pocket maximum.

I am absolutely furious about how deceptive this language is. The sessions don't fit inside my budget if I actually have to pay far more than $3250 per year out of pocket. I now have to stop seeing my therapist because of the unexpected expense.

Is this common? How is it legal to use the language of "out-of-pocket maximum" if it's not actually the maximum you pay out of pocket? Is there any way to protect myself from this kind of deception in the future? (I had called Blue Shield CA at least a dozen times previously and this was never mentioned.)

submitted by /u/EZBake33
[comments]