I must have been on the phone with my insurance company at least 30 minutes today. It seemed like longer. I confused the rep. who answered my call but I think we figured it all out in the end.
What it comes down to is that I have weird insurance. I start every year with a $750 credit that rolls over if I don't use it. I had $200 from last year so I had $950 to use. Some things are covered 100% like procedures and diagnostics. Things like office visit charges and overhead fees get subtracted from my credit but it doesn't explain it well on the bill it just looks like everything is being covered 100%. When the credit runs out then I have to pay a $1,000 deductible but some things are still covered and some are not. This is the point I am at. My credit is gone and they have started applying charges to the deductible. So I owe $444 so far. After the deductible is met then most things will be covered 90%. I pay the 10% up to $2,500 and then I am covered 100%...at least I think that's what she said.
Next week when I go to my out-of-network dermatologist I will pay cash to get the discount. Then I will submit my bill and receipt to the insurance company and they will process it as out-of-network. If they could have gotten me a better deal they will give me a refund. If not, they will apply all or part of what I paid to my deductible. I hope I don't have any more medical bills this year but either way it will be nice to get the deductible out of the way just in case. I did not know I could submit the bill myself last year when I went to the same doctor. Luckily I didn't have any other medical bills so it didn't matter. It is too bad that insurance is so complicated and you really don't figure out how it works until (often) its too late.