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I am searching for a tool to look up EOC's as well as SoB's. I recall there may be a web link for both. A BCBS rep just told me and my client that although a plan's full MOOP may have been met in network, this plan has an additional full deductible for out of network. It's a 2014 Marketplace plan.
The SoB for the plan does not mention anything about a second deductible, only that the disallowed portions of the bill don't count toward MOOP. So, by my reading, if the plan pays 60% of their allowable amount (still using UCR in some form, I imagine) for OON, then the client is out the 40% + excess over "allowable" charges. In network, of course, they would pay 100% after MOOP.
The SoB for the plan does not mention anything about a second deductible, only that the disallowed portions of the bill don't count toward MOOP. So, by my reading, if the plan pays 60% of their allowable amount (still using UCR in some form, I imagine) for OON, then the client is out the 40% + excess over "allowable" charges. In network, of course, they would pay 100% after MOOP.