What happens if my benefit maximum is reached half way through a claim payment?
We’ll illustrate what happens using the following example: • The member has $50 remaining on their benefit maximum (has met $2,450) • The approved amount for the drug is $150 • BCBSM pays $50, reaching the member’s $2,500 maximum • Member pays $75 copayment (50 percent of $150), plus $25 (the amount remaining of what would have been BCBSM’s obligation if the benefit maximum hadn’t been reached) • Member pays: $100
Related Questions
- What happens when the insurance company sends the payment for a claim to the patient rather than the provider? Can we bill the patient the entire amount?
- What happens if the individual has already purchased the maximum added benefit available (typically £5,000)?
- What happens if my benefit maximum is reached half way through a claim payment?
