BCBS ppo insurance question

Karmic108

I met my high deductible and oop max.

But some services were done earlier are not billed yet, but eventually. I am guessing they will be 0 as I met my ded and oop.

Does the ded and oop gets applied based on the order of processing date or based on the order of service date.

It might be an insurance question.

But what is your experience.

After sometime do they reprocess all the claims based on service date.

JoniB

Hi - processing date.

beach2beach

Yup like the OP said, processing date. Whomever gets their bill in first it gets applied to ded, ,paid or denied, whatever the case may be

Leydi

Just chiming in to agree with the previous posters. I've had a high-deductible health plan through a BC/BS PPO for years. While the deductible and maximum co-insurance amounts will be applied in the order they are processed, there are a couple clarifications that I would like to add:

1. My plan "resets" on January 1 so any services that I received through December 31 and the claim processed in January are still processed as if they were from the previous calendar year and not the new year.

2. My zero cost after reaching my global out of pocket maximum still only applies to in network services. Much higher bills can still be expected for anything out of network. Unfortunately, I've been bit a couple times by this despite my attention to utilizing only in network services. It's usually been lab work.

Once you've reached your out of pocket maximum, be sure to go ahead and take advantage of any other covered services that you've been putting off.

Karmic108

Great thanks

Castigame

I just would like to add my two cents. As expected I met my oops max when DXd in calendar 2017. Added elbow lump removal. Total hysterectomy. Colonoscopy. Endoscopy. Series of cardiology tests. And all medicine I needed. Of course my health insurance started sending me do this preventive ck and that after 2017.