Paying for surgery

[Guest guest]

Hello, My name is dan and I will have lower advancement in about 1

month or so. I just talked to my oral surgeon today and was getting

some particulars about payment. My insurance is Bluecross/blueshield

federal plan. My insurance will not give a pre authorization for this

surgery. My doctor today told me that I would have to pre pay for the

hospital and for anethsia. which is around $6,000. They said since I

am pre-paying it will not go thru insurance and that will be out of

pocket for me. They said if I dont pre pay and submit to insurance

and it is denied i would be looking at around a $14,000 hospital bill

alone. This does not sound right to me. Has anyone had any experience

with this before or have this kind of insurance? I Really need help

on this one. My the fee for surgery will be around 6,000 of which my

doctor wants me to pre pay a portion of also.

Thanks

Dan

[Guest guest]

Hmmm. My daughter's oral maxillofacial surgeon is a preferred

provider on the BCBS federal plan. When I mentioned to him that I

was thinking of switching to this plan during open enrollment he

said that they approve almost 100 pct of these types of surgeries.

Perhaps you should call the insurance and inquire further.

> Hello, My name is dan and I will have lower advancement in about 1

> month or so. I just talked to my oral surgeon today and was

getting

> some particulars about payment. My insurance is

Bluecross/blueshield

> federal plan. My insurance will not give a pre authorization for

this

> surgery. My doctor today told me that I would have to pre pay for

the

> hospital and for anethsia. which is around $6,000. They said since

I

> am pre-paying it will not go thru insurance and that will be out

of

> pocket for me. They said if I dont pre pay and submit to insurance

> and it is denied i would be looking at around a $14,000 hospital

bill

> alone. This does not sound right to me. Has anyone had any

experience

> with this before or have this kind of insurance? I Really need

help

> on this one. My the fee for surgery will be around 6,000 of which

my

> doctor wants me to pre pay a portion of also.

>

> Thanks

>

> Dan

[Guest guest]

My experience with this is that I had to have my doctors submit a

letter to the review panel of my insurance plan (United) and we had a

PPO for heaven's sake! After they denied it twice, I finally got

approval THE DAY BEFORE SURGERY! I was freaking out. The point is,

let your surgeons be your activists. If the surgery is medically

necessary (not just for aesthetics) then your insurance plan needs to

pay for it, but of course they are going to drag their feet and kick

and scream. You just have to push push push. I did relentlessly and

I'm glad, because my so-called $15,000 estimate turned into a $32,000

bill when I left the hospital. I had an infection and required extra

care and longer stay. You never know about these things. Get on

your insurance company and surgeons NOW!

Good luck!

> Hello, My name is dan and I will have lower advancement in about 1

> month or so. I just talked to my oral surgeon today and was getting

> some particulars about payment. My insurance is

Bluecross/blueshield

> federal plan. My insurance will not give a pre authorization for

this

> surgery. My doctor today told me that I would have to pre pay for

the

> hospital and for anethsia. which is around $6,000. They said since

I

> am pre-paying it will not go thru insurance and that will be out of

> pocket for me. They said if I dont pre pay and submit to insurance

> and it is denied i would be looking at around a $14,000 hospital

bill

> alone. This does not sound right to me. Has anyone had any

experience

> with this before or have this kind of insurance? I Really need help

> on this one. My the fee for surgery will be around 6,000 of which

my

> doctor wants me to pre pay a portion of also.

>

> Thanks

>

> Dan

[Guest guest]

Dan -

My insurance company is also BCBS, and the claim was initially

denied. My surgeon had to " appeal " by submitting more information

and x-rays. My understanding is it is very common for insurance

companies to deny claims initially and force the appeal process.

Presumably this weeds out the people who aren't really serious.

The cost of everything will be higher if you pay out-of-pocket. For

example if your surgeon's normal fee for this procedure is $6000,

the insurance company may only pay him $3000 for the same

procedure. By being an " in-network " physician with the insurance

company, the surgeon gets more patients than he otherwise would, so

he can afford to take less for each patient. The same applies to

the hospitalization costs.

If your surgeon doesn't want to pursue this with the insurance

company, you might want to talk with another surgeon. Also, talk to

your ortho about it. Try to make sure you are working with " in-

network " physicans and hospitals.

Good luck,

Jay

> > Hello, My name is dan and I will have lower advancement in about

1

> > month or so. I just talked to my oral surgeon today and was

getting

> > some particulars about payment. My insurance is

> Bluecross/blueshield

> > federal plan. My insurance will not give a pre authorization for

> this

> > surgery. My doctor today told me that I would have to pre pay

for

> the

> > hospital and for anethsia. which is around $6,000. They said

since

> I

> > am pre-paying it will not go thru insurance and that will be out

of

> > pocket for me. They said if I dont pre pay and submit to

insurance

> > and it is denied i would be looking at around a $14,000 hospital

> bill

> > alone. This does not sound right to me. Has anyone had any

> experience

> > with this before or have this kind of insurance? I Really need

help

> > on this one. My the fee for surgery will be around 6,000 of

which

> my

> > doctor wants me to pre pay a portion of also.

> >

> > Thanks

> >

> > Dan

[Guest guest]

I have PacificSource and UnitedHealthcare. PS denied the pre-

authorization because of very specific TMJ & Orthognathic exclusions.

UHC approved my first pre-authorization and my portion would've been

$100 co-pay. My surgery was scheduled for 12/31/03, but was

postponed. UHC reassured that my surgery will still be covered

during 2004. My surgeon submitted to UHC the new surgery date for

the authorization. We were going to reschedule for sometime in

September 2004, but UHC had the nerve to DENY the updated

authorization. SHOCK...DENIED... I couldn't believe it and couldn't

hold back the tears when I found out. UHC is claiming TMJ exclusions

are in the policy, and yet the policy hasn't changed since the first

approval. The Dex Media HR department isn't helping us at all, and

they won't provide us with the medical benefit handbook that lists

the exclusions. Their answers to our questions don't have anything

to do with our questions. It is a big run around via emails. I am

now in the appeals process with UHC. My surgeon will write a letter

for a second appeal, if this first appeal is denied. If a second

and/or third appeal is denied, then I will probably seek splint (bite

plate) treatment in lieu of the surgery because I don't have $10-20k.

` Swanson

> > > Hello, My name is dan and I will have lower advancement in

about

> 1

> > > month or so. I just talked to my oral surgeon today and was

> getting

> > > some particulars about payment. My insurance is

> > Bluecross/blueshield

> > > federal plan. My insurance will not give a pre authorization

for

> > this

> > > surgery. My doctor today told me that I would have to pre pay

> for

> > the

> > > hospital and for anethsia. which is around $6,000. They said

> since

> > I

> > > am pre-paying it will not go thru insurance and that will be

out

> of

> > > pocket for me. They said if I dont pre pay and submit to

> insurance

> > > and it is denied i would be looking at around a $14,000

hospital

> > bill

> > > alone. This does not sound right to me. Has anyone had any

> > experience

> > > with this before or have this kind of insurance? I Really need

> help

> > > on this one. My the fee for surgery will be around 6,000 of

> which

> > my

> > > doctor wants me to pre pay a portion of also.

> > >

> > > Thanks

> > >

> > > Dan

[Guest guest]

Your surgeon and his staff should be very experienced with handling

this type of situation. If they can show that you have a deformity

that needs to be corrected because of functional problems, that

usually satisfies the criteria.

Also, another doctor told me, there is one word that insurance

companies really HATE to see on any kind of formal correspondence.

That word is " exacerbate " . If your doctors can show that without

treatment your condition will worsen, then for liability reasons the

insurance company really needs to think twice before denying the

claim.

Again, this should be routine for your surgeon. I would not worry

about it.

Jay

> > > > Hello, My name is dan and I will have lower advancement in

> about

> > 1

> > > > month or so. I just talked to my oral surgeon today and was

> > getting

> > > > some particulars about payment. My insurance is

> > > Bluecross/blueshield

> > > > federal plan. My insurance will not give a pre authorization

> for

> > > this

> > > > surgery. My doctor today told me that I would have to pre

pay

> > for

> > > the

> > > > hospital and for anethsia. which is around $6,000. They said

> > since

> > > I

> > > > am pre-paying it will not go thru insurance and that will be

> out

> > of

> > > > pocket for me. They said if I dont pre pay and submit to

> > insurance

> > > > and it is denied i would be looking at around a $14,000

> hospital

> > > bill

> > > > alone. This does not sound right to me. Has anyone had any

> > > experience

> > > > with this before or have this kind of insurance? I Really

need

> > help

> > > > on this one. My the fee for surgery will be around 6,000 of

> > which

> > > my

> > > > doctor wants me to pre pay a portion of also.

> > > >

> > > > Thanks

> > > >

> > > > Dan