Sorry if this is long. My son just had a sistrunk procedure done. It was the second time doing this, since the first time it failed. The first time was covered by an HMO and we’re done paying for it. It didn’t work, and the cyst came back. In the meantime we moved out of state (to CO), got on a (UHC) PPO plan, and had to do the surgery again. The surgery had a major complication or three, and he ended up undergoing a second surgery, and stayed in the PICU for three nights. I’m pretty sure we’ll be hitting the OOP max. My questions are: What can we expect? Should we pay bills as they come in because we’ll be hitting the OOP max anyway, or wait until most or all of the bills come in? Will we be paying the family OOP max or the individual one for just him? How do in and out of network OOP maximums work? Do in-network payments count towards out of network OOP maximums? I forgot to check if the procedure itself was covered because I assumed it is and our previous plan covered it. In the event that it is not, will the emergency second surgery be covered? I would call UHC to find out since their website is not helpful in finding this, but wanted to see what else to ask about first.
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