Wednesday, July 06, 2005

Out-of-pocket maximum...?

So, apparently, when someone tells you about an "out-of-pocket maximum", it does not actually mean the maximum amount of money that could come out of your pocket. It means something different, depending on who is telling you and what they are holding back. For instance, my health insurance provider, Blue Cross of California (they must be a bad one), defines it as such:

"Out-of-Pocket Maximum: Refers to the maximum amount that a covered person will have to pay for expenses covered under the plan. It is a sum of deductible and coinsurance amounts."

However, although my insurance is with them, my employer opted for a plan that has a different definition of "out-of-pocket maximum." This NEW definition of the phrase says that it is not the sum of deductible and coinsurance amounts, but rather just the total of coinsurance payments.

When it comes to words, I expect them to mean the same thing when dealing with the same material. Up means up, and down means down. An out-of-pocket maximum at $1,000 should always mean an out-of-pocket maximum of $1,000. Instead, sometimes it means $1,000 plus your $400 deductible...which is clearly an out-of-pocket maximum of $1,400.