Out-of-pocket maximum error
The out-of-pocket max was reached. The next bill still asked for payment.
The plan totals showed the patient had reached the annual out-of-pocket maximum. A later EOB and invoice still assigned a new patient balance.
OOP remaining$0
Later patient charge$310
Max statusReached
What happened
1
The plan cap was already reached
Coverage totals showed the patient had no out-of-pocket amount remaining for the plan year.
2
A later claim still assigned responsibility
The next processed claim and provider bill showed a $310 patient balance despite the annual cap.
3
The cap conflict was surfaced
Insured Guard flagged the charge because the active-period out-of-pocket maximum had already been reached.
After the out-of-pocket max, new covered in-network charges should not quietly restart the bill.
How do we know
It applies the annual cap before accepting a new balance.
Insured Guard tracks out-of-pocket accumulation from processed claims and plan data. When the remaining amount is $0, later patient responsibility is flagged unless the documents show an excluded service or different coverage period.