Are the cost of excluded-from-your-plan medical services still subject to a maximum out of pocket benefit?

Question

Meaning, if you have a max out of pocket of 4k and you want to have a medical service performed that costs 10k, the cost of which is not covered by your plan because while it is considered a medical service, it is specifically listed as being "not covered" by your plan docs -- do you pay 4k and your insurace pays the rest or are you responsible for the entire cost of the service?

Answer 1

If the procedure is not covered, then it will not count as part of the max out of pocket. If you believe it should be covered because it is medically necessary, then you can petition to have them cover it, but it may take months for them to decide and even then they may still reject the claim.

Answer 2

if your insurance doesn't cover it, you pay the entire cost, and it does not apply to your annual maximum out of pocket amount.