r/HealthInsurance • u/Pretend_Confusion475 • 13d ago
Plan Benefits Need help understanding
I don’t know how any of this works. I’m on med mutual insurance through my wife. She is a state of Ohio employee. In Feb 2024, we had a kid, and I’m assuming we met our out of pocket maximum (I don’t really know). I got a colonoscopy in December 2024, and JUST got the bill in the mail, they said they billed insurance in 2024 but it was never mailed to me. Idk…
Anyway, the procedure was $3,609. An ‘insurance contract w/o’ for -1,703.45, minus a 1,527.33 insurance payment, with my responsibility of approx $380.
Why would I owe $380? Shouldn’t this be covered? Does my wife giving birth in Feb 2024 affect this at all?
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u/BaltimoreBee Moderator 13d ago
$380 is 20% of the allowed amount, which is a pretty typical coinsurance. You presumably did not hit the family OOP max yet…if your plan has embedded OOP maximums then your wife may have reached hers but you wouldn’t have reached yours…
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