Guest guest Posted March 29, 2005 Report Share Posted March 29, 2005 Any suggestions for someone whose only nearby provider is bordering on incompetent? After hearing scary things from three medical professionals, I decided to go with the highly regarded surgeon three states away. Unfortunately, he's not a preferred provider and he's not cheap. I am assuming I'll have to pay all but about $2,500 of his fees. Luna > > This is all for folks in the U. S. of A. Sorry, to all others. I > don't know your systems nearly as well. > > A little hard-won help in deciphering all this... > > " Usual and customary " for BC/BS, here, anyhow, is what they will pay > for a specific procedure. (It turns out to be " surgery " when I have > cortisone injections in my wrists or thumbs for arthritis. Also CT > scans, x-rays, dental work, eye exams, you name it. Anything in > hospital, or in the Emergency Room is different. With different > deductibles, as are therapies of assorted types.) > > > > The short cut is that this is the fee that BC/BS authorizes in your > individual policy (and maybe in all policies) for payment for a > specific service. If your caregiver is a preferred care provider, he > or she has agreed to accept this amount as full payment for that > service. If not, he or she is at liberty to charge you the full > amount; BC/BS will pay their approved fee, and you are responsible > for the difference. > > They always tell me how much " I saved " by using a preferred care > provider. > > " Usual and customary " are almost invariably the lower amount they > will pay. I grieve for those who cannot afford (or even manage to > pay) for coverage that gets them such breaks, as they are often > huge! And the charges BC/BS is billed are often many times > the " usual and customary " charges. > > You do not want to know how I know this. > > If you can work with a surgeon who is a preferred care provider, you > may find that you save many, many dollars... I did choose to use an > ortho who won't deal with all this, because I could work with him, > because he was near, and because I thought I had the funds to deal > with it. If I'd been willing to drive 70 or more miles each way, > there was an in-network ortho who would have given me the services, > I think, at the rate my DENTAL insurance would have paid. I would > have saved thousands of dollars. I do not regret my choice. > > two other options: Check into the provisions in your policy about > exceptions for those who have no nearby providers. Or, get to be > goood friends with your banker, lender, whatever. And, yet another: > Check out a dental school, which might give you a lower rate. > > > > > C. Quote Link to comment Share on other sites More sharing options...
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