Hi all,
I have an Ambetter Silver plan through the ACA marketplace, which I purchased primarily because I knew I was going to have surgery and it would be the lowest-cost option. It's a higher premium but a lower deductible.
I met the deductible in March due to my surgery.
Today I had my regular therapy session and I was told that my deductible "reset" and that it's starting from 0. I was told that if I hit my deductible in the first 6 months of the year, it resets for the second half. But if I don't hit it, it doesn't reset to 0.
I've never heard of this before and I can't find anything about this rule in the materials. But I called the insurance company and they confirmed this true. But my insurance also told me to check my member portal to see if I'm covered, which still l says I've hit my deducible and am covered.
I'm super confused and would appreciate any guidance on this.
UPDATE: So, I called my insurance again. The first person said this was true. The second person said I shouldn't have to pay anything since I've hit my deductible, but they didn't address if this is true or not. She did confirm that my coverage was until Dec. 31st 2023.
There isn't a defined limit for therapy -- it says "no limit" and the provider was listed as in-network (if this changed, that's not what I was told).
I'm planning on visiting my provider tomorrow to explain what the insurance said and ask for more specifics from their side.
Update 2: So, I spoke with the clinic today and it was explained a little better. Their reference from the insurance company in their system showed that my insurance is a 6-month plan (even though it also shows coverage of Jan-Dec). But it's not, it's a full year. No where on my portal does it say it's a 6-month plan, nor do I have a "renewal notice". It says coverage from Jan-Dec.
Luckily, I had written to my insurance yesterday and received a response that I had met my deductible and shouldn't be charged. This should resolve it.
Thank you all for your answers and support in figuring this out!
I have an Ambetter Silver plan through the ACA marketplace, which I purchased primarily because I knew I was going to have surgery and it would be the lowest-cost option. It's a higher premium but a lower deductible.
I met the deductible in March due to my surgery.
Today I had my regular therapy session and I was told that my deductible "reset" and that it's starting from 0. I was told that if I hit my deductible in the first 6 months of the year, it resets for the second half. But if I don't hit it, it doesn't reset to 0.
I've never heard of this before and I can't find anything about this rule in the materials. But I called the insurance company and they confirmed this true. But my insurance also told me to check my member portal to see if I'm covered, which still l says I've hit my deducible and am covered.
I'm super confused and would appreciate any guidance on this.
UPDATE: So, I called my insurance again. The first person said this was true. The second person said I shouldn't have to pay anything since I've hit my deductible, but they didn't address if this is true or not. She did confirm that my coverage was until Dec. 31st 2023.
There isn't a defined limit for therapy -- it says "no limit" and the provider was listed as in-network (if this changed, that's not what I was told).
I'm planning on visiting my provider tomorrow to explain what the insurance said and ask for more specifics from their side.
Update 2: So, I spoke with the clinic today and it was explained a little better. Their reference from the insurance company in their system showed that my insurance is a 6-month plan (even though it also shows coverage of Jan-Dec). But it's not, it's a full year. No where on my portal does it say it's a 6-month plan, nor do I have a "renewal notice". It says coverage from Jan-Dec.
Luckily, I had written to my insurance yesterday and received a response that I had met my deductible and shouldn't be charged. This should resolve it.
Thank you all for your answers and support in figuring this out!