What is my Max Out-of-Pocket if I go out of network?
Well, this could be very bad news! Could be as much as $28,350 for an
Individual. Got your attention?
If so, keep reading. The MOP-Max Out-of-Pocket is not your
deductible, it is the maximum amount of your personal out-of-pocket that
you may be responsible for in any given plan year. And keep in mind, ALL
plan deductibles as well as MOPs are reset as of Jan 1 st each new year!
Happy New Years!! Yes, you can meet your deductible in the latter part of
the year, and you will restart an all-new deductible and MOP come the new
year. Many MOPs for the plan year are $9,450 (IF you remain IN-
Network!), and a few plans are as little as $7,900, and in special
circumstances where you have a reduced Out-of-Pocket, some as low as
$3,150. Bottom line, they vary greatly, and it is always a good idea to know
yours! And a little good news, it’s right on your ID Card, just take a sec to
look, be aware and be prepared.
But what if you go Out-of-Network? Well, it could be more than TRIPLE
your IN-Network Max Out-of-Pocket!!! On my Bronze POS 6500 plan, I
have $28,350 MOP if I was to go out-of-network. That’s seems a bit
ridiculous, however, it would be challenging to go out-of-network on the
POS Plans via Blue Cross. But what if I have a more limited network such
as Blue Connect, Signature, Community, Precision, and others? Then you
must be more mindful that you stay within your prescribed IN-Network.
These plans are generally more narrowed networks that limit your ability to
just go wherever you might like. So, what should I do? Always, make sure
your Doc is within your network, especially if there might be an upcoming
surgery, that could potentially trigger your MOP assuming a major expense
on the surgery. The key word in this situation is “preauthorization”!
Always, talk with your doctors and hospital facilities to make certain you
remain within your network, and avoid having to meet a MOP of $28,350!
Here’s a tad bit of good news! If you happen to be skiing in Utah, break
your leg, wound up at the ER in UT, then most Emergency Room visits will
be treated as IN-Network and generally calculated accordingly. If you have
a continued stay in an Out-of-Network facility, then we are right back to the
key word, “preauthorization”! Particularly if there may be a follow up
operation while still out of town??
Didn’t mean to scare anyone! But, knowing is the only way you can
potentially avoid this situation and be prepared properly.
To sum it all up, when in doubt, ASK!
This is a new addition to the “What the Health?” newsletter that I will try to
keep brief and to the point. Hopefully, this may help shed a little light on a
somewhat complex health insurance world.
You’ve got Q’s, I hope I have your answer! Always feel free to call Kevin
most anytime. Text or call 985-778-0072.