I have $2.5k in out-of-pocket expenses, but only ~$400 applied to my $700 deductible. My insurance terms weren’t clear on this, so I called them. After a confusing call, they confirmed my prescription copays didn’t count toward the deductible. However, they couldn’t tell me what counts. After holding for 45 minutes, they hung up.
How can I find out what applies to my deductible?
Do I just pay out-of-pocket until I hit the maximum?
My labs alone exceed my deductible, but it seems none of it applies.
If you have set copays, like I do ($20 for a 90-day supply of generics and a $20 copay for a primary care visit), these usually do not count towards your deductible. However, they do go towards your maximum out-of-pocket limit. Last year, I reached my out-of-pocket maximum without meeting my deductible because I only had a lot of copays.
To get your plan documents, check the materials your employer provides or visit your insurance company’s website. These documents contain important details about your benefits.
I’ve been in a similar situation with insurance confusion and dealing with out-of-pocket expenses. To find out what counts toward your deductible, you should review your insurance policy documents carefully, as they usually detail what expenses apply. If the information isn’t clear, try contacting your insurance company again and ask for a written explanation or a detailed statement. It might also be helpful to speak with a billing representative from your healthcare provider, as they can often clarify what costs will apply to your deductible. Until you get a clear answer, you might need to continue paying out-of-pocket and keep track of all expenses. Additionally, you could consider escalating the issue to a supervisor or a patient advocate within your insurance company if you keep having trouble getting a resolution.