Can someone answer a question regarding medical

[Steve Verno]

I dont trust an insurance EOB as far as I can throw an elephant. 

there are many unknowns here.

Scenario A
Wimpy goes to see Dr. Detroit.  Wimpy has insurance with BCBS.  Dr Detroit is not contracted with BCBS.  Wimpys insurance is under ERISA regulation.  The charge for the visit is $200.  Dr. Detroit is entitled to be paid $200.  Wimpy's policy may say that BCBS pays 60% of BCBS's allowed amount.  It may also say that Wimpy pays the other 40% and any amount above the BCBS allowed amount.  So, BCBS allows $100 and pays $60.  Wimpy owes the doctor $140. 

Scenario B
Dr Detroit is still not contracted with BCBS.  BCBS pays $60. Wimpy still owes the $140 to Dr Detroit, BUT BCBS may be required to pay 100% of Wimpy's out of pocket medical expenses, so BCBS paid the claimwrong. BCBS words the EOB so that it looks like they dont owe anything and so they can intimidate the doctor into not billing Wimpy.   Wimpy must appeal the BCBS payment per Federal Regulation 29 CFR 2560-503-1 and still owes Dr Detroit the $140 until BCBS pays the 100%.  Wimpy has appealed and lost and must now go to Federal Court to get BCBS to pay the $140. 

Scenario 3
Wimpy has a BCBS plan that only allows $x for a visit or x number of visits.  Wimpy has exceeded the $ amount or number of visits. Any amount that is beyond the $x or when Wimpy exceeds the number of visits, is to be paid by Wimpy.  Again, this is an unknown because we dont know your plan contract contents. Any answer is a guess.

[Alexandra]

billing/collections? I have BCBS PPO and my obgyn (which are in-network) is billing me for $141.90 stating that the insurance processed the claim but because my benefit plan reached max-that I'm responsible for the balance. On the EOB it states BCBS allowable was $145.86 with patient's coin of $3.96-no where does it state that I am responsible for $141.90. But the dr's office is telling me that I am responsible for the difference between the allowable $145.86 and $3.96 because my benefits reached max. I have spoken to BCBS and they have told me that I am not responsible for the $141.90. That I'm only responsible for the $3.96 as coinsurance. So who is correct here? Can my DR bill me for the $141.90?