February 14th, 2010 → 6:22 pm @ admin // 3 Comments
I have Blue Cross/Blue Shield of Tennessee PPO, but I live in Pennsylvania. My coinsurance says 70%, so I believe that means I am responsible for 30%. My deductible is $1,000, but it also says that my in-network out-of-pocket limit is $5,000. I am probably going to have a few surgeries this year now that I have insurance.
I will be going to an Ear, Nose, and Throat doctor for my tonsils, which will probably need removed. The average cost for this surgery is about $5,000.
I will be going to a gynecologist and will more than likely need a DNC, Average cost for this procedure is also about $5,000.
I also need to go back to my neurologist to have another MRI of my brain (I have seizures and had a stroke). I’m sure the cost of this will be over $10,000, since I’m sure he will also order another CAT scan, etc.
I’m just wondering if this means that no matter how high up my medical costs go this year, I only have to pay 30% until I end up paying $5,000 out-of-pocket, then I only pay for doctor’s visits?
Tags: Coverage, Having, Health, Insurance, Trouble, Understanding
cnuswte
1 year ago
First of all, you have to pay that deductible- per year. After that, BC/BS of Tennessee PPO will pay 70% and you will have to pay the 30%. The maximum that you would have to pay per year out of pocket is $5,000. After that, insurance will pay 100% until the maximum- which most maximums are in the millions, I believe.
dreamgir
1 year ago
I think you will have to pay 1000 for each surgery for the deductible.until you get to the 5000 limit..And you will have to use their in-network doctors.
Amy W
1 year ago
I work for Blue Cross. Beings it is a ppo plan, make sure all your providers are ppo. Including the anesthesiologist if you have surgery. Also check where you are having the surgery, hospital vs surgery center. Make sure they are ppo as well. You will owe your deductible $1000 plus 30% of the ppo allowance up to scenario0 So worst case scenerio is $6000 per your benefit year. If you go out of network, those claims will apply out of network and that is usually double what the in network is and it is a mess. If you have dr office copays, you will still have them even if you meet your out of pocket expense.