Can someone help me understand my health insurance?

For in network medical treatment you pay 100% of the first $1400 in expenses. After that, you pay a percentage, often it's 30% (copay). The maximum in a year you will spend is $5250. Out of network, the deductible is $3400 and maximum is $12000. Often the copay is higher as well. Some plans only cover $20%.

Your deductible is an annual amount you may need to pay out of pocket for certain kinds of medical care per year before the insurance company will begin to assist you with costs. The out-of-pocket maximum is the most you would have to pay per year for covered medical services – this generally includes your deductible and may also include other forms of cost-sharing like copayments or coinsurance. Rules on these things can vary a bit from one state or insurer to another, however, so clarify with your insurance company. Don’t be too scared by your deductible. $1,400 is fairly low, actually, and some kinds of medical care should be covered before the deductible – things like preventive screenings, women’s health care, immunizations, and probably an annual checkup. It’s sick-visits to the doctor and other kinds of services that generally apply toward your deductible. With regard to the in-network and out-of-network stuff – just keep things simple for yourself and only visit in-network doctors and hospitals. When a medical provider is in-network that means they’re under contract with your insurance company to accept a discounted rate as payment in full for covered procedures. An out-of-network provider isn’t required to do that. Your insurance may pay something towards care rendered by an out-of-network doctor, but you’re going to end up with a lot more of the bill than you would with an in-network doctor.

follow up information to this mess. In network doctors have negotiated a (hopefully) lower fee for your insurance program. A in network dr might charge you $100 but full retail is $200. A out of network Dr may charge you $200, or you may get them to accept $100 providing you pay cash and they don't have to deal with the insurance company. Insurance company typically owes a typical doctor $200,000 which is why the Dr. is out of network. If the in network Dr charges you $200, the in network Dr. will accept $100 from the insurance company and eat the rest. Blue cross typically gets a 60% discount.

It means, the insurance doesn't pay one penny, until AFTER you've paid the first $1400 in medical bills, with your in network doctor. After that, you still pay a portion of the medical bills, check your coinsurance amount to find out what that is. Insurance doesn't pay EVERYTHING, until you've paid your $5250 worth of medical bills.

That means that it does not cover all the fees. It means that if you see only doctors that are in the network, and do not see doctors out of the network, then it does not cover $1400-$5250 of the fees, so you have to pay $1400-$5250 (depending on how much the fees were) yourself, with your own money. It means that if you also see doctors that are not in the network, then it does not cover $3400-$12000 of the fees that there would have been if you had seen doctors in the network, so you have to pay $3400-$12,000 of those fees, plus if the doctors out of the network charge higher fees than the doctors in the network, then you also have the pay the difference, in addition to the $3400 to $12,000.