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  • Steven Corn

You Down With O.O.P?

About this time of year, kids are going back to school and summer vacation photos are being looked at nostalgically.  Autumn is also a good time to take a look at your OOP benefits on your medical insurance policy.

"OOP" stands for "out of pocket".  (Don't confuse this with the hit song by Naughty By Nature:  "I'm Down with O.P.P.").  It is a very important benefit of health insurance policies that can really help insured that have high amounts of medical bills.  That's because insurance policies put a limit on the total OOP expenses an insured has to spend in a calendar year.  After that limit (or cap) is met, then the insurance company will pay 100% of medical services.

Those with a modest amount of medical issues are likely still seeing if their annual deductible has been met.  But those with a greater need for medical care are looking at their OOP about now.  If you have met your OOP limit, then essentially all of your medical care for the rest of the year is free.

But there's a catch.  (Isn't there always?)  When you go to a doctor's office or a facility, they will check your insurance coverage and ask for your applicable co-pay.  DON'T PAY IT!  The typical office staff will not be able to see if your OOP maximum is met.  They only see what the co-pay is and how much the insurance coverage will pay.

It's up to YOU to know when your OOP cap is met.  It's up to YOU to inform the front office that you are covered 100%.  It's up to YOU to say "No" to the requested co-pay.

You should know that if you do pay the co-pay (even when it is not necessary), you will almost certainly get this money back at some time after the bill has been processed by the insurance company.  But why overpay and wait for a refund?  It's your money.  Keep it in your pocket.

So, are you down with your O.O.P.?  Check and find out.

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