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You need to know both your deductible and out of pocket maximum numbers. You’ve said your deductible is $1500. For the sake of this example let’s say your out of pocket max (OOP from now on) is $2500.
For simplicity, we’ll go with your insurance’s negotiated rate for the procedure is $1000*. Meaning at the end of the day you and your insurance combined will pay the hospital $1000.
Basically any bills up to $1500 for the year you pay 100%. Between $1500 and $2500 (or your OOP), insurance pays 50% and you pay 50%. Over $2500 insurance pays 100%.
Some examples to illustrate:
Why is this all so convoluted and, seemingly, legal? Is this purposely convoluted to obfuscate illegal activity?
I don’t know the actual answer. My theory is it’s this confusing so it’s hard for the general population to catch the mistakes. This allows insurance companies get out of paying as much as they’re supposed to. And hospitals don’t really care who does the paying, as long as they get paid