I have had several surgerys this year. My health insurance deductable is $7,500, then 80-20 of the next $9,000. I started getting letters from my insurance company about in October that I had met my 7,500 and all of my out of pocket for 2005 and they started paying at 100%. I then made some desisions based on the fact that my deductable was completely met. Now I'm getting letters stating that my out of pocket has not been met and that I am still at 80-20. Can they change this on me, for any reason and what should I do?

I have had several surgerys this year. My health insurance deductable is $7,500, then 80-20 of the next $9,000. I started getting letters from my insurance company about in October that I had met my 7,500 and all of my out of pocket for 2005 and they started paying at 100%. I then made some desisions based on the fact that my deductable was completely met. Now I'm getting letters stating that my out of pocket has not been met and that I am still at 80-20. Can they change this on me, for any reason and what should I do?


You need to call a customer service representative and ask what your plan benefits include.

Perhaps some procedures are covered at 100% after deductible, and other procedures are still subject to your 80% coinsurance. It's not uncommon for that to happen.