Met out-of-pocket maximum...now what?

CeciliaVera
CeciliaVera Member Posts: 59
edited October 2014 in Employment, Insurance, and Other Financial Issues

Hello, all!  When it comes to working out insurance matters, my usually sufficient brain seems to go numb (though I have learned more than I ever cared to know about all of this during these 2 BC diagnoses).

Can you help me prepare before I call insurance to ask some Qs?  Please bear with me if these queries seem silly or obvious. 

I have already paid my out-of-pocket max of $2000 for this year, so what does that mean for the mountain of bills I have yet to pay?  All were with in-network providers. Looks like I owe about $1000 more.  Can I bundle the bills and get on a payment plan?  How do I go about requesting something like that? 

Do nurse navigators help with bill management, or are they more of a medical resource?

I have Regence Blue Cross Blue Shield.  Do they offer anyone who can advise me?  To start chipping away at all this, should I call them first or call the # on the bills themselves?     

What do I need to save/show for tax purposes re: out-of-pocket medical expenses?  For instance, if I saw a naturopath, bought special supplements, and rented a recliner for after surgery, can those expenses be written off?

Can you think of anything you wish you had known before navigating this sort of territory?

Thanks in advance.  Good health to all!

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Comments

  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2014

    Not sure how the out of pocket max is handled as  I have a no deductible, no co-insurance, co-pay only plan,  but my understanding is that once you have met your out of pocket your insurance should cover your bills in full - or payment from insurance with your physician/hospital writing off the balance.  You should not owe anything in addition to what you have already paid out to meet the out of pocket max.  In terms of taxes, your total expenditures must exceed a percentage of your income.  If they don't you can't claim them.  I believe that anything that is medical in nature - including mileage to and from appointments - is deductible as long as it exceeds 10% of your adjusted gross income on your federal taxes.  I believe that it is 7.5% if you are 65 or older.

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  • glennie19
    glennie19 Member Posts: 6,398
    edited October 2014


    I would start with Blue Cross.  My understanding is that if you have met your out of pocket for the year,, they are supposed to pick up the rest of the bills. Confirm that with them.  Then tell them about these bills. Fax them copies if necessary.  And keep a journal of phone calls, who you talked to and faxes, etc.

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  • naiviv
    naiviv Member Posts: 535
    edited October 2014

    Hi,

    I have Blue Cross BS ,Florida Blue.  I thought the same thing. When I met my in net work out of pocket, I still had to pay for office visits and certain copay and deductibles like hospital admissions.  Certain tests and chemo were fully covered.  But they have a maximum benefit allowed per day in different categories.   Call them, they have persons who can help with bills when you have been diagnosed with an illness, they can help find net work places for tests to avoid more charges, as well as answer questions about bills. I think they are called patient coordinators. My Nurse navigator has helped with appts and explanations, not sure if they do finance. 

    As for taxes, save everything thay may be medical or medically connected.

    Good luck

    Vivian

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  • TwoHobbies
    TwoHobbies Member Posts: 2,118
    edited October 2014

    CV, once I have met my out of pocket maximum then all the rest of my bills are paid in full.  I imagine your insurance company has a website and you can see your explanation of benefits there.  It is definitely handy to get registered on and you can usually download all the claims and check them. 

    P.S.  Usually the out-of-pocket refers to "covered" expenses.  So if you went to a naturopath, I'm sure that is not covered by your medical plan.  Same with the recliner.  But if you have in-network surgery, doctors, etc that add up to the $2000, then the rest of the "covered" expenses should be paid for in full.

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  • Spookiesmom
    Spookiesmom Member Posts: 9,568
    edited October 2014

    my rads co pays ran me past my deductible, that was in March , 13. After that, for that year, I didn't pay any more, any where. I had a Humana plan. They are all different, give them a call.

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  • pajim
    pajim Member Posts: 2,785
    edited October 2014

    Cecilia, there are three places to turn on this.  First is to get a navigator (probably not a nurse) from your insurance company.  It's a good place to ask questions but they probably aren't invested in helping you save money.

    Second, your cancer center probably has someone who can help.  They are interested in getting paid, and they are interested in getting paid by the insurance company, not you.  And they're used to dealing with this.

    Third, your state may have an insurance commission who can answer questions.

    To answer your specific questions, I assume that if your policy has a $2000 out-of-pocket maximum for a given year, insurance will payerything after $2000.  This would be for "covered" services.  Non-covered services you are out of pocket.

    You can deduct anything over 2.5% of income on Schedule A of your tax return.  You need to keep the canceled checks, receipts, etc.  The IRS definition of medical expenses is likely to be different (broader) than BCBS.

    Pam

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