Reply to What is not counted towards the maximum out of pocket for health insurance

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[quote=Anonymous]I have a $4,000 max out of pocket with my insurance (Kaiser if that matters). Typically I never come close to it but two months ago I was diagnosed with a kidney stone and had the removal operation last week. Between the initial diagnosis costs (a trip to the hospital for an analysis and scans and bloodwork following two days of deep red urine) and the surgery itself, I've paid just about $4,000 out of pocket, including the $1600 deductible.

I thought I'd now be at the max and that would mean healthcare for the rest of the year is basically free. But the insurance company is telling me that, no, I'm still only $1800 towards the max. I'm currently asking for more information and a detailed breakdown of the services I've received to understand what is counted towards the max and what isn't, as it doesn't make sense to me.

Fortunately I'm not worried about the money, I can easily afford this, but I'd long thought the maximum out of pocket meant exactly that, the most amount you'd ever spend for healthcare in a given year. Crossing fingers the insurance billing department hasn't caught up with the surgery and payment for it, which was just last week, but I'm steeling myself for a lengthy fact finding battle with Kaiser, who is pretty abysmal in giving you information. Can anyone clarify what may actually be going on? Note all services have been with Kaiser and I do not go to anyone outside Kaiser. [/quote]

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