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Phillips Esq.
Phillips Esq., Attorney-at-Law
Category: Family Law
Satisfied Customers: 17179
Experience:  B.A.; M.B.A.; J.D.
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I want to know how much my actual out-of-pocket will be

Customer Question

I want to know how much my actual out-of-pocket will be after my wife gives birth (let's just assume its $20,000 in total bills). There are some confusing language and numbers in my health insurance plan:
Individual deductible is $1,000.
Coinsurance is $3,000, but it also says that they'd pay 70% and we'd pay 30%.
Max out of pocket is $6,850.
Will we need to have $4,000 or $6,850? Everything I've read says that once you satisfy your coinsurance amount then the heath insurance company pays 100% - but we cannot figure out why the max OOP is still $2,850 beyond that....
I will gladly send over the PDF that was sent to me from my company's HR dept.
Thank you
Submitted: 24 days ago.
Category: Family Law
Expert:  Phillips Esq. replied 23 days ago.

Hello: This isCustomer Welcome to JustAnswer! I am reviewing your post, and I will post my response very shortly. Thank you for your patience.

Expert:  Phillips Esq. replied 23 days ago.

I am not sure how they arrived at the maximum out of pocket of $6,850.00 either.

If the deductible is $1,000.00 and your co-insurance is $3,000.00 and they would also pay 70% of the co-insurance ($2,100.00), then your maximum out of pocket should be $3,100.00.

You need to find out from HR how they came up with $6,850.00 and why they have your coinsurance as $3,000.00, but then indicate that the company would also pay 70% of that.

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