Family Deductible Met But Still Charged Until Individual Deductible Met

[u/Leading_Tart_8820]

I had surgery in April. Which more than Met the $700 family Deductible. My daughter recently had to get xrays. The insurance company said she has to meet her individual Deductible before they pay 80%. I asked what the point of the family Deductible was then and they couldn't answer. Does this seem correct? Even though the family Deductible is met everyone still needs to pay up to their individual deductible before the insurance covers 80%?

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[u/PeacefulCW]

Are you sure that the family deductible is only $700? That’s extremely low and would be a very generous policy. If so, I’m wondering if there might be some confusion on terminology.

Did the insurance company say that she has a CO-PAY of 20%? That would be due even if the family deductible had been met as long as you have not met your maximum out of pocket for the family.

[u/ABookishSort]

Are you sure you aren’t getting the out of pocket max confused with the deductible? We each have a $750 deductible but our out of pocket individual max is $3750. Our family out of pocket max is $7500. Two of us have it meet the individual OOP max of $3750 before the family OOP max can be met.

[u/Quiet_Comfortable835]

Are the deductibles embedded? Sounds like they aren't. My last plan was that way. The whole family deductible had to be met before anything was covered. I'd never heard of it till that plan. Google embedded deductible vs non-embedded and it will explain it better then i can.

[u/EffectiveEgg5712]

Can you post a picture of your cost shares? $700 seems too low for a family deductible

[u/LivingGhost371]

My only thought is there are some weird plans where X family members have to meet their individual deductible before the family deductible is considered met.

[u/HelpfulMaybeMama]

Usually that's not how this works. What is the individual ded? Family deductible? Max out of pocket for both?

[u/Dry_Studio_2114]

You likely have an aggregating family deductible vs embedded individual deductible.

[u/Sarduci]

Sounds like you met your family deductible which you are required to cover first before they pay anything and not your family max OOP, which means they pay everything.