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Old 02-20-2017, 02:33 PM   #16
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Not quite, CinderAbby. What she is saying is that - If Lenny hits the $5000 personal maximum, HE will pay nothing else for the rest of the year. If Lenny hits the $10000 family maximum, YOUR ENTIRE FAMILY pays nothing else for the rest of the year.
See, this is where I'm confused. If Lenny hits $5000 and doesn't have to pay any more, then how could he possibly hit the $10,000 mark for the entire family? Doesn't that mean I'd have to pay $5000 in expenses that I shouldn't be paying for him?
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Old 02-20-2017, 03:19 PM   #17
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Be sure to double check the co-pay policy for your insurance. My insurance, even when I meet the Max OOP, I still have to pay co-pays. I know that doesn't seem right when it is Max OOP, but that's the rules. I found that out in 2014 when I had my breast cancer situation. I met the max OOP, but I still had to pay the co-pay at every doctor visit. Luckily it was only I think 3 visits if memory serves (one $60 and two $70's) since it was December when I hit the max OOP.
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Old 02-20-2017, 04:37 PM   #18
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Originally Posted by CinderAbby View Post
See, this is where I'm confused. If Lenny hits $5000 and doesn't have to pay any more, then how could he possibly hit the $10,000 mark for the entire family? Doesn't that mean I'd have to pay $5000 in expenses that I shouldn't be paying for him?
If Lenny hits the 5000 max, then whatever expenses past that he will pay a percentage of the balance until he hits $10000. If that happens, then the whole family is good. If Lenny hits the 5000 max and is cured, then you and Abby will need to have $5000 in cost before the whole family is covered 100%. That's how I understand it.

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Old 02-20-2017, 04:40 PM   #19
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You have got to talk to the HR department if through a company or talk to someone at the insurance company who knows what they are talking about.

When I hit my out of pocket max with my ex's great policy, I did not have to pay anything more for doctor's visits or procedures. I still paid my prescription copays.

With my last year's policy even though I had a low deductible and maximum, so much was not counted by the insurance company, I ended up paying more altogether, And the cost difference was minimal (better policy was through employment, stinky one was individual.)

To me the good news is most hospitals will work with you to pay bills. And many have funds that will help if you are unable to even pay minimal amounts.

One of the things that surprised me was I have met people who have had similar health issues to mine, did not have insurance and yet got the same care (and often more because I considered the cost where they did not).

It's a horrible mess. If this is the insurance through Home Depot, talk to someone in the corporate HR department. The other thing that plays into employer based coverage in the state the insurance contract is in. Your in MA so coverage should be great, if you get HOme Depot coverage through Tennessee, it may notbe as good.

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Old 02-20-2017, 05:23 PM   #20
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CinderAbby, Please check with Home Depot's HR. Some employment based plans use healthcare networks. If that is the case, anytime you seek medical care within the network you pay only a co-pay, which counts towards your annual deductible.
If you seek care outside of the network, you will pay a percentage of the bill (in my case 20%). All plans are different. These payments also count towards your annual deductible.
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Old 02-21-2017, 10:33 AM   #21
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Yes, Darlene, please talk to Home Depot's HR department. Insurance policies vary so much as you can see from the above posts. It is best to discuss with someone YOUR policy rather than these general experiences so you know what to truly expect!
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