You need to know both your deductible and out of pocket maximum numbers. You’ve said your deductible is $1500. For the sake of this example let’s say your out of pocket max (OOP from now on) is $2500.

For simplicity, we’ll go with your insurance’s negotiated rate for the procedure is $1000*. Meaning at the end of the day you and your insurance combined will pay the hospital $1000.

Basically any bills up to $1500 for the year you pay 100%. Between $1500 and $2500 (or your OOP), insurance pays 50% and you pay 50%. Over $2500 insurance pays 100%.

Some examples to illustrate:

1. You’ve paid $400 this year so far. You pay the full $1000: $400 + $1000 = $1400 which is less than your deductible of $1500
2. You’ve paid $1000 so far this year. You pay $750 and insurance pays $250: $500 gets you to the $1500 deductible limit so you have to pay all that, plus you pay 50% of the remaining $500 bill = $250.
3. You’ve paid $1700 so far. You pay $500 and insurance pays $500. $1700 + $500 = $2200 which is less than your OOP of $2500
4. You’ve paid $2300 so far. You pay $200 and insurance pays $800. 50% of $1000 = $500 but $500 would put you over your OOP of $2500. $2500 - $2300 = $200. You pay $200 and insurance pays the rest.
5. You’ve paid $2500 so far. Insurance pays $1000

• If your insurance’s negotiated rate for the procedure is $1000, this means that’s what the hospital and insurance have agreed to pay. A lot of times you’ll see the hospital “charge” a larger number and then have an insurance “discount” but ignore this. It doesn’t factor into deductible or out of pocket maximum calculations.