Friday, December 14, 2012

Out of Pocket Expenses

As a follow up to my post on Wednesday....I had to wait for my $60 to post to the account.  I had the option of receiving a paper check as a refund (4-6 weeks!), or an EFT back to the originating account.  Um, EFT please.  It will take 2-3 business days, so I am hoping it will be returned by Wednesday.  The bill I was paying is due by 12/21 (Friday), so it should be ok.  Lesson learned.....triple check the transaction before you hit GO.

Today's topic....$9.

We got an EOB yesterday, and it showed we are NINE dollars away from hitting out out of pocket maximum for the year.  Yes, we have paid $5,000 out of pocket, not including dental, prescriptions, or premiums.  Or technically....we have paid $4,991.

Once we hit the max, the rest of the year is "free."  No co-pays for anything, prescriptions at no cost.  This is when we refill all the meds.  :)

The frustrating thing about this $9 is that it may not exist.  We can call the insurance company, and usually they give us the same info we have in front of us.  We keep asking about PENDING claims, and they always tell us there are none.  We call BS....we have at least one appointment every week.  Don't tell me you are totally caught up.

G-man has an appointment today, and I am telling him NOT to pay the co-pay.  This provider is very slow in her billing, so I know that by the time she submits, we will be in the clear.  Bossy has an appointment tomorrow....same deal.

Next week I have 2 appointments, and the kids have an eye appointment.  If I am wrong....they will bill me for the co-pays.  But I am positive there is something in the cue that will push it over the edge.  I will wait, however, to refill the meds until I get the official notice.  Since those co-pays don't count toward our out of pocket expenses. 

When the kids were younger, and we had more appointments for them....we would hit this point much earlier in the year.   That, plus our out of pocket max was only $4,000.  I miss those days.

Anyone else hit their out of pocket maximum for the year???


  1. Unfortunately, yes. Believe it or not, we hit our out-of-pocket max in March. Yep, that's right, March. I have four kids (two are adults) and thank goodness for Obama care they can stay on our insurance until 26. My kids have chronic genetic illnesses, as do I, and deal with depression/anxiety as well. It doesn't take long to max out.

  2. Free as in until Dec 31? You must have good insurance, our OOO is $2500 but I've paid a good $5,000 in medical bills this year, I'm still not sure how that OOO works...


  3. Yep, if we make it to April before hitting our OOP it's a good year. DS's machines run $3,000 a month alone. Routine hospital clinic visits are about $750. Doesn't take long for it to add up. Of course, like HS, that doesn't mean our expenses end there. Always something that's "not reasonable and customary" and therefore our problem. Ugh. Hope you're able to max out soon and reap some benefits!


  4. Mysti--after listening to the news today, I have been thinking about you and your family. (I'm not sure exactly where you live,) but if you have a chance please check in and let us know how you are doing. My thoughts and prayers are in Connecticut today.

  5. This year is the first time I've ever even hit my deductible. Its an 80/20 split after that on rx --- however, I dont think i have anything that will be refilled before the 31st!