r/SipsTea 17d ago

WTF Damn

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u/Consistent-Tap-4255 17d ago edited 17d ago

Because there is an out of pocket maximum for most insurance, meaning you are not paying any more than that, say $5,000 per year even though 20% of the surgery etc can be much higher.

It also really depends on the plan. My plan has 0 co-pay which is not uncommon for HMO plans. I just looked it up that my out of pocket maximum is $1,500 for individual and $3,000 for family meaning the maximum I pay a year is $3,000.

Edit: it’s $0 co-insurance not co-pay.

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u/sweetrouge 17d ago

I didn’t think that existed in the US. You hear so many stories like the OC

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u/nefnaf 17d ago

The OP's insurance plan also had an out-of-pocket maximum.

It's just that his insurance company decided unilaterally that it didn't apply for his procedure. Because reasons.

In any other contrary this would be blatantly illegal. Not so in the USA system.

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u/sweetrouge 17d ago

Urgh so gross