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Reply to "Help me understand out of pocket maximums"
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[quote=Anonymous]Only the “allowable amount” counts towards your OOP Max. So for example, I see an out of network specialist. That doctor charges me $450 for an office visit. UHC’s “allowable amount” is $120. So only $120 gets counted, and I still owe the doctor $450. I see this doctor frequently, and those $120 credits finally add up to $6,000. I’ve paid $22,500 out of pocket at this point. I go back to the doctor. Since I have hit my OOP Max, UHC covers the “allowable amount” of $120. I still owe the doctor $330. This is an oversimplification, because there are likely deductibles and coinsurance involved. Also because it’s rare to just see a specialist that often and have no other medical expenses (lab work, prescriptions, etc). And as PP said, it’s a completely separate accounting than for your in-network expenses.[/quote]
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