MAPD PPO Out of Network Surgery, Experiences?

yorkriver1

Guru
1000 Post Club
1,735
Virginia
Looking for your experiences with clients who have had surgery out of network on MAPD PPO's. Costs are the question. Medicare allowable charges being a limiting factor.

Looks like the Medicare Allowable Charges would have to exceed just over $33,000 for all the $10K to be used up.

Have you had clients up to the limit? Issues with balance billing?
 
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