Co-pays and Out of Pocket max

[newone]

I have met my out-of-pocket max - $5000. Saw my neuro last month and just got a bill for $50 (the amount the co-pay would be). Called my insurance company and asked why the bill wasn't paid in full since I had met my out-of-pocket max. The insurance company told me I must continue to pay my co-pays and the insurance company will, in turn, reimburse me. Does this make any sense? Anyone else have this happen?
Am suppose to get physical therapy and speech therapy - was excited that my out-of-pocket had been met and I could now get the therapies. There's a co-pay involved - (which I can't afford) and I'm very concerned that I'll won't get reimbursed.

[kristin_t]

That does not make much sense to me, but unfortunately I'm not sure if that actually means anything.

I would call again and see if you get the same answer. (Usually that happens to me when I don't want it to!!)

If that doesn't work I would contact your insurance agent or your benefits department/person if this is through an employer and get them to explain and/or intervene. Or perhaps the biller at your therapist's office could verify the claims are being coded properly or give you other advice?

What type of policy is this? High deductible? HMO? PPO?

I have had very frustrating experiences with my insurance company as well on behalf of my whole family. And there's no manual or class to figure out the system! I hope you are able to get the therapy you need without unnecessary stress. I wish you the best with this.

[agate]

I have dental insurance and there have been times when I had to pay and wait to be reimbursed. The insurance company should reimburse you. If it doesn't, you can squawk--after making sure you save any evidence that you've paid.

[Parsi]

Unfortunately it makes "sense" to me. Not in the real world, but in the world the insurance guys live. :(

[renee]

Everything makes sense in someone's world.

Demanding prior approval of a non controlled prescription drug at 5 pm on friday
should be a crime punishable by a one minute beating of the insurance CEO.

It's my bad self speaking.
The angry woman in me.

[newone]

Well three phone calls later and I've yet to get a refund for the $50 co-pay I paid last August (after reaching my out of pocket max...). Next stop is State Insurance Department.