Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Hi all.....I am having a little problem with insurance and was wondering if anyone has decided to do this. My surgery is on Monday 4-30. My insurance has not approved me to go out of network yet...but they do have self referred or out of network benefits of 80%...then I will have to pay 20% with a max out of pocket of $2,250...It seems like I have waited forever to get to this point and don't want to rescedule my surgery. I was wondering if anyone did a self referral out of network....and if you had a problem with them paying.....I have been told countless times that this is a covered procedure if medically necessary and explained the coverage if I decide to go out of network....I am now afraid that if I decide to do this what if they don't want to cover anything? Then I will be left to pay everything...I am so confused. Any self-payers out there, how much was your surgery? Where you allowed to make payments? Did the surgeon and/or hospital take a lesser amount if your insurance didn't come through? I just need to know what my options are at this point....who knows, maybe they will approve me to go out of network...but until then, I can't stop thinking about it. Thanks so much to everyone in here.....it doesn't seem that long ago that I found this group and was welcomed with open arms.....and now here I am .....surgery in a little over a week... Bobbi-jo 4-30-01 Dr. Elariny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Thanks so much to everyone in here.....it doesn't seem that long ago that I found this group and was welcomed with open arms.....and now here I am .....surgery in a little over a week... Bobbie Jo, sorry you are in this postion and I can definitely relate. I haven't gotten my final approval yet either, and had to hold off on my scheduled pre op testing for this past Saturday, due to this. I am still hopefull and praying that a miracle will come through and that I will still be having my surgery the day after you on the 1st. I also made my hotel reservations for the days after the surgery in hopes that all will be worked out. I am hoping for the same for you. I know how disappointing it is to have these hang ups with insurance. Kathy 5/1 ( hopefully) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Thanks so much to everyone in here.....it doesn't seem that long ago that I found this group and was welcomed with open arms.....and now here I am .....surgery in a little over a week... Bobbie Jo, sorry you are in this postion and I can definitely relate. I haven't gotten my final approval yet either, and had to hold off on my scheduled pre op testing for this past Saturday, due to this. I am still hopefull and praying that a miracle will come through and that I will still be having my surgery the day after you on the 1st. I also made my hotel reservations for the days after the surgery in hopes that all will be worked out. I am hoping for the same for you. I know how disappointing it is to have these hang ups with insurance. Kathy 5/1 ( hopefully) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2001 Report Share Posted April 21, 2001 Thanks so much to everyone in here.....it doesn't seem that long ago that I found this group and was welcomed with open arms.....and now here I am .....surgery in a little over a week... Bobbie Jo, sorry you are in this postion and I can definitely relate. I haven't gotten my final approval yet either, and had to hold off on my scheduled pre op testing for this past Saturday, due to this. I am still hopefull and praying that a miracle will come through and that I will still be having my surgery the day after you on the 1st. I also made my hotel reservations for the days after the surgery in hopes that all will be worked out. I am hoping for the same for you. I know how disappointing it is to have these hang ups with insurance. Kathy 5/1 ( hopefully) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 Although I was not the same as you I was however, a self-pay until insurance approved. My situation was either do it now and pay or wait a year or more. So, I payed and crossed my fingers. First I was denied and then I was covered for all except the DS part of the surgery which ended up costing about $6,000. I payed the hospital with a " package " deal of $18,000 for 3 days and I think something like 80% of the fee of any days past. I ended up staying four days. The last day cost $9,000 which they came looking for far faster than I anticipated. Well, they were good about it and eventually my insurance approved and reimbursed the hospital. I was worried like you. It didn't change a thing or help.I think you should call whoever it is you need to and get the answer so you can focus on you health and recovery. sincerely, Brigid Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 Although I was not the same as you I was however, a self-pay until insurance approved. My situation was either do it now and pay or wait a year or more. So, I payed and crossed my fingers. First I was denied and then I was covered for all except the DS part of the surgery which ended up costing about $6,000. I payed the hospital with a " package " deal of $18,000 for 3 days and I think something like 80% of the fee of any days past. I ended up staying four days. The last day cost $9,000 which they came looking for far faster than I anticipated. Well, they were good about it and eventually my insurance approved and reimbursed the hospital. I was worried like you. It didn't change a thing or help.I think you should call whoever it is you need to and get the answer so you can focus on you health and recovery. sincerely, Brigid Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 Although I was not the same as you I was however, a self-pay until insurance approved. My situation was either do it now and pay or wait a year or more. So, I payed and crossed my fingers. First I was denied and then I was covered for all except the DS part of the surgery which ended up costing about $6,000. I payed the hospital with a " package " deal of $18,000 for 3 days and I think something like 80% of the fee of any days past. I ended up staying four days. The last day cost $9,000 which they came looking for far faster than I anticipated. Well, they were good about it and eventually my insurance approved and reimbursed the hospital. I was worried like you. It didn't change a thing or help.I think you should call whoever it is you need to and get the answer so you can focus on you health and recovery. sincerely, Brigid Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 bobbi-jo, i have the same kind of self referral 80/20 out of network benefits, also. i have not done this as i am still waiting for approval (calling monday to make sure my info has been submitted) but i would be very interested in what happens with this. i would document phone conversations with your insurance company regarding your benefits so that you have some ammo if they decided to give you a hard time about this. good luck! see you in ds chat. erika 5'2 " , 281.5#, bmi 51.5 surgery date 5.11.01 11:30 am dr. herron > ...My insurance has not approved me to go out of network > yet...but they do have self referred or out of network benefits of > 80%...then I will have to pay 20% with a max out of pocket of > $2,250...It seems like I have waited forever to get to this point and > don't want to rescedule my surgery. I was wondering if anyone did a > self referral out of network....and if you had a problem with them > paying..... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 bobbi-jo, i have the same kind of self referral 80/20 out of network benefits, also. i have not done this as i am still waiting for approval (calling monday to make sure my info has been submitted) but i would be very interested in what happens with this. i would document phone conversations with your insurance company regarding your benefits so that you have some ammo if they decided to give you a hard time about this. good luck! see you in ds chat. erika 5'2 " , 281.5#, bmi 51.5 surgery date 5.11.01 11:30 am dr. herron > ...My insurance has not approved me to go out of network > yet...but they do have self referred or out of network benefits of > 80%...then I will have to pay 20% with a max out of pocket of > $2,250...It seems like I have waited forever to get to this point and > don't want to rescedule my surgery. I was wondering if anyone did a > self referral out of network....and if you had a problem with them > paying..... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2001 Report Share Posted April 22, 2001 bobbi-jo, i have the same kind of self referral 80/20 out of network benefits, also. i have not done this as i am still waiting for approval (calling monday to make sure my info has been submitted) but i would be very interested in what happens with this. i would document phone conversations with your insurance company regarding your benefits so that you have some ammo if they decided to give you a hard time about this. good luck! see you in ds chat. erika 5'2 " , 281.5#, bmi 51.5 surgery date 5.11.01 11:30 am dr. herron > ...My insurance has not approved me to go out of network > yet...but they do have self referred or out of network benefits of > 80%...then I will have to pay 20% with a max out of pocket of > $2,250...It seems like I have waited forever to get to this point and > don't want to rescedule my surgery. I was wondering if anyone did a > self referral out of network....and if you had a problem with them > paying..... Quote Link to comment Share on other sites More sharing options...
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