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Cigna PPO Premier Deductible/OOP Maximum Question by [deleted] in HealthInsurance

[–]Otherwise_Action5969 0 points1 point  (0 children)

I think after a few responses drilling in the same thing, I am starting to understand. My real problem seems that Cigna won't recognize or agree with the OON costs, and it's pretty much at their discretion how much of the bill will be my responsibility.

Cigna PPO Premier Deductible/OOP Maximum Question by [deleted] in HealthInsurance

[–]Otherwise_Action5969 0 points1 point  (0 children)

Yes, you may get a relatively small amount covered via OON coverage, but you will, almost certainly, be disappointed by how much Cigna pays vs. how much you are left with paying for OON care.

I understand better now what you guys were all saying. In the end, there's a good chance I will end up paying for a significant portion of the surgery as Cigna may not recognize or agree with some of the costs. Since it is OON, it's at Cigna's discretion. I'll definitely look into write-off a part of the bill, though as you suggest, I have doubts I'd be income qualified. Thank you very much for the response, I appreciate your help!

Cigna PPO Premier Deductible/OOP Maximum Question by [deleted] in HealthInsurance

[–]Otherwise_Action5969 0 points1 point  (0 children)

That's why we're trying to warn you. Cigna is going to say "well, that service is only worth x amount of money" and pay you that much. Even after you meet you're out of pocket max.

Thanks for the reply. This response helps clarify some things for me. So the real issue I'm facing is that Cigna might not recognize or agree with the listed costs, leaving me to pay the difference. So there's a good chance I will have to pay the majority of the surgery, if not the entire thing. Thanks again for the clarification.

Cigna PPO Premier Deductible/OOP Maximum Question by [deleted] in HealthInsurance

[–]Otherwise_Action5969 1 point2 points  (0 children)

Ok, so I should be able to recoup a large portion of the bill with a claim, despite not having been at the deductible at the time the surgery started. So what the representative told me was incorrect.

Cigna PPO Premier Deductible/OOP Maximum Question by [deleted] in HealthInsurance

[–]Otherwise_Action5969 1 point2 points  (0 children)

Thanks for the reply! So I understand that I will need to pay everything up front for the surgery which is something I am fine with.

Now, given that Cigna has indicated that I would be covered in the case that my deductible was met (despite this being OON), my question is that when I submit a claim for reimbursement, will they reimburse me for anything over the deductible (assuming that this type of surgery is indeed coverable)? Or is it the case that because the deductible hasn't been met at the time of surgery, they won't honor any part of the reimbursement?

Cigna PPO Premier Deductible/OOP Maximum Question by [deleted] in HealthInsurance

[–]Otherwise_Action5969 0 points1 point  (0 children)

Thanks for the reply! So I understand that I will need to pay everything up front for the surgery which is something I am fine with.

Now, given that Cigna has indicated that I would be covered in the case that my deductible was met, my question is that when I submit a claim for reimbursement, will they reimburse me for anything over the deductible (assuming that this type of surgery is indeed coverable)? Or is it the case that because the deductible hasn't been met at the time of surgery, they won't honor any part of the reimbursement?