Step-NA is on his mom's medical insurance for primary coverage. He was in the hospital recently and has had a lot of procedures done. His deductible is $3,000 as an individual. His mom claims that her policy states that the plan pays 100% after that, and the OOP max is $6,000. Copays go toward the OOP max but not the deductible.
My question is, is this a common setup? How would we even get to the $6k OOP max if only copays count toward the $3k difference? It just seems odd to me.
This is in-network only we're talking about; out of network is completely different and not included here.
Bonus question: He is on my insurance as secondary coverage. My deductible is $800 for an individual. How does that generally work? Is it worth applying any of his bills to my insurance company, or will I get nothing? I understand that it's probably on a case-by-case basis, but any general insights would be great.
My question is, is this a common setup? How would we even get to the $6k OOP max if only copays count toward the $3k difference? It just seems odd to me.
This is in-network only we're talking about; out of network is completely different and not included here.
Bonus question: He is on my insurance as secondary coverage. My deductible is $800 for an individual. How does that generally work? Is it worth applying any of his bills to my insurance company, or will I get nothing? I understand that it's probably on a case-by-case basis, but any general insights would be great.
Can someone explain this to me?