Confused about medical coverage

[ladycpd]

New here!

I have met my deductible for this year, but a couple of my last claims against my insurance only covered part of the claim. I can’t figure out why.

I’m not sure what information I need to provide to help answer this question.

Here are a couple key pieces of information:

                                                Used         Max

1. Deductible YTD $187.95 $1,500
2. PPO deductible YTD $500.00 $1,500
3. Family Deductible YTD $187.95 $4,500
4. PPO family deductible YTD $500 $4,500

I know my deductible is $500 and I have met that. I am not on a family plan. I’m the holder of the insurance and the only person covered. The charge in question deemed that I owed $187.95. I had another visit that my insurance only covered half and my responsibility is $50.94. I can’t understand this, please help.

ETA:

Age: 26 Income: $56,000 Zip: 84780

 

[foreverthankful]

@ladycpd Meeting your deductible does not mean that everything you receive after is covered at 100% unless your plan also has a 500 out of pocket max.

Even then- it has to be medically necessary, non-excluded and in network.

 

[ladycpd]

@foreverthankful So if it’s a doctor that I see regularly and in network, and medically necessary, what could be the cause?

I assume that the $187 is from a visit where I suspected I had a uti and from my urine, she said that I did not and I pushed to have a culture tested and it came back that I did. If she put that I did not have a uti, could that be the cause?

 

[foreverthankful]

@ladycpd No, you probably have a charge for the testing, check your EOBs in your insurance portal.

Again, unless you also hit your out of pocket maximum, you will owe your percentage of coinsurance for any care you get after meeting your deductible.

 

[ladycpd]

@foreverthankful I understand, but I do not have co-insurance and I have not had to pay anything above my co-pays at the time of my visit. I have gone to this doctors a handful of times along with my other drs without paying anything for testing or the appointment.

 

[ellieanna]

@ladycpd After your deductible there may be co-insurance. You're gonna have to call your insurance customer service on Monday.

 

[ladycpd]

@ellieanna Under my accumulators , my co-insurance lines all have $0

ETA: I plan to call Monday, was hoping to have some relief before then