Insurance experience

[Guest guest]

I had a big laugh today when I got my explanation of benefits from

CIGNA on the hospital's claim for my March surgery (upper, lower,

turbinectomy and cheek implants). CIGNA had already paid my surgeon

around $ 6000 on his $ 23,000 claim. The hospital's claim was for

49,000 (does not include the anesthesiologist). CIGNA paid the

hospital around $ 2000. Some of you may remember my complaining

several months ago about how my surgeon's office was decidedly

unhelpful in pursuing my appeals after CIGNA denied my original

claim. After seeing what CIGNA actually pays on these claims, I can

see why a doctor's office would not work very hard to get a claim

covered--I would have had to pay him 23,000 up front if it had not

been covered. Obviously, acting on that disincentive would be

unethical, etc., but it sure makes you wonder.... Can you imagine

49,000 for a 6 hour surgery and about a 15 hour stay afterwards?

Very humorous.

[Guest guest]

What is not funny is that they DO charge individuals MUCH MORE

than insurances. Should be opposite as they get cash now, but no!

You can try to negotiate but you never get down to the insurance

rates. They say they do it to recover from many non-paying patients

- how unfare is this?

Val

> I had a big laugh today when I got my explanation of benefits from

> CIGNA on the hospital's claim for my March surgery (upper, lower,

> turbinectomy and cheek implants). CIGNA had already paid my

surgeon

> around $ 6000 on his $ 23,000 claim. The hospital's claim was for

> 49,000 (does not include the anesthesiologist). CIGNA paid the

> hospital around $ 2000. Some of you may remember my complaining

> several months ago about how my surgeon's office was decidedly

> unhelpful in pursuing my appeals after CIGNA denied my original

> claim. After seeing what CIGNA actually pays on these claims, I

can

> see why a doctor's office would not work very hard to get a claim

> covered--I would have had to pay him 23,000 up front if it had not

> been covered. Obviously, acting on that disincentive would be

> unethical, etc., but it sure makes you wonder.... Can you imagine

> 49,000 for a 6 hour surgery and about a 15 hour stay afterwards?

> Very humorous.

[Guest guest]

I hate to tell you, if you don't know already, but this is true

almost across the board in my own experience with things medical and

dental. Blue Cross, for example, has set fees for procedures, and

their preferred providers agree to accept whatever the " usual and

customary " rate is.

But the poor souls who have no medical insurance are stuck with

paying whatever the doc lists -- and that can be thousands of dollars

more in an expensive course of treatment.

It seems backward to me, too, but that's how it is. I was surprised

to learn that some surgeons will actually offer patients who are

paying cash and have no insurance a price break.

Cammie

> > I had a big laugh today when I got my explanation of benefits

from

> > CIGNA on the hospital's claim for my March surgery (upper, lower,

> > turbinectomy and cheek implants). CIGNA had already paid my

> surgeon

> > around $ 6000 on his $ 23,000 claim. The hospital's claim was

for

> > 49,000 (does not include the anesthesiologist). CIGNA paid the

> > hospital around $ 2000. Some of you may remember my complaining

> > several months ago about how my surgeon's office was decidedly

> > unhelpful in pursuing my appeals after CIGNA denied my original

> > claim. After seeing what CIGNA actually pays on these claims, I

> can

> > see why a doctor's office would not work very hard to get a claim

> > covered--I would have had to pay him 23,000 up front if it had

not

> > been covered. Obviously, acting on that disincentive would be

> > unethical, etc., but it sure makes you wonder.... Can you

imagine

> > 49,000 for a 6 hour surgery and about a 15 hour stay afterwards?

> > Very humorous.