Re: How MUCH does this cost?

[Guest guest]

Hi Cammie,

Thanks for your message. It looks like the biggest cost is the hospital fee,

because the

Stanford hospital is so expensive and I don't imagine I could get Dr. Riley to

go to a

different hospital to do the surgery.

When you mentioned the cost, was that entirely out of pocket or was that the

total that

was passed on to your insurance company? I want to try to see what (if

anything) my

insurance company will cover. I just wish I could have a full breakdown of the

components

and costs instead of (as it appears Dr. Riley's office wants me to do) calling

the hospital,

anaesthesiologist, etc to get costs for each component, etc.

Thanks,

> >

> > I recently saw an oral surgeon, Dr. Riley (in Palo Alto),

> and am considering having

> > upper jaw surgery to correct my openbite/crossbite/class III.

> >

> > I finally decided to go ahead with orthodontics, but I have to say,

> Dr. Riley's office has not

> > been terribly helpful here. I called them and they wouldn't really

> give me any information

> > and told me to call my insurance company; they are not in any

> insurance network.

> >

> > I have coverage through a large company with BlueCross (in their

> PPO plan). I asked Dr.

> > Riley's office if they could give me an estimate but they said they

> don't deal with insurance

> > companies, plans, etc...although I'm SURE they must have had

> another patient who had

> > BlueCross PPO.

> >

> > All I want to know is what I will be required to pay, out of

> pocket, for this surgery. I have

> > called BlueCross and they are almost entirely clueless---plus all I

> can tell them is that I

> > would be having orthognathic surgery of my upper jaw. They told me

> to call the doctor,

> > but the doctor tells me to call the insurance company. When I

> asked about the hospital

> > fee, the person I spoke with at Dr. Riley's office told me to call

> the hospital. I mean this is

> > really ridiculous that there is apparently 0 coordination here.

> >

> > Dr. Riley (when I met with him) indicated that the gross fees for

> this surgery, including his

> > fee + hospital fee, would most likely be upwards of $50,000 as the

> hospital fee is $30,000

> > per day. (ridiculous, in my opinion). If I have this surgery and

> am stuck with a $50,000

> > bill, I will not be thrilled nor financially capable of paying it.

> >

> > Is there some way to streamline this process to find out (a) if the

> insurance company will

> > cover anything, ( what they will cover, © what an approximate

> out of pocket cost is?

> >

> > It would be really helpful if anyone from this area (Bay Area,

> California) has gone through

> > this with BlueCross PPO.

> >

> > Thanks so much,

> >

> >

[Guest guest]

Oops! I didn't have upper at all. What I had was lower advancement

only. Sorry.

C.

> >

> > I recently saw an oral surgeon, Dr. Riley (in Palo Alto),

> and am considering having

> > upper jaw surgery to correct my openbite/crossbite/class III.

> >

> > I finally decided to go ahead with orthodontics, but I have to

say,

> Dr. Riley's office has not

> > been terribly helpful here. I called them and they wouldn't

really

> give me any information

> > and told me to call my insurance company; they are not in any

> insurance network.

> >

> > I have coverage through a large company with BlueCross (in their

> PPO plan). I asked Dr.

> > Riley's office if they could give me an estimate but they said

they

> don't deal with insurance

> > companies, plans, etc...although I'm SURE they must have had

> another patient who had

> > BlueCross PPO.

> >

> > All I want to know is what I will be required to pay, out of

> pocket, for this surgery. I have

> > called BlueCross and they are almost entirely clueless---plus all

I

> can tell them is that I

> > would be having orthognathic surgery of my upper jaw. They told

me

> to call the doctor,

> > but the doctor tells me to call the insurance company. When I

> asked about the hospital

> > fee, the person I spoke with at Dr. Riley's office told me to

call

> the hospital. I mean this is

> > really ridiculous that there is apparently 0 coordination here.

> >

> > Dr. Riley (when I met with him) indicated that the gross fees for

> this surgery, including his

> > fee + hospital fee, would most likely be upwards of $50,000 as

the

> hospital fee is $30,000

> > per day. (ridiculous, in my opinion). If I have this surgery

and

> am stuck with a $50,000

> > bill, I will not be thrilled nor financially capable of paying it.

> >

> > Is there some way to streamline this process to find out (a) if

the

> insurance company will

> > cover anything, ( what they will cover, © what an approximate

> out of pocket cost is?

> >

> > It would be really helpful if anyone from this area (Bay Area,

> California) has gone through

> > this with BlueCross PPO.

> >

> > Thanks so much,

> >

> >

[Guest guest]

That was the bill from the hospital, which my insurance covered. As a

matter of fact, my wonderful insurance policy (provided mostly by my

kind employer) covered everything except the rental fee on a suction

machine my surgeon insisted that I take home. I never even opened the

thing up -- I was fortunate enough not to have any nausea.

That is a nuisance to have to get separate quotes from each provider.

I would imagine that things are more expensive, generally, in

California than they are here in Alabama.

All my docs, and my hospital, were in-network, which no doubt helped.

C.

>

> Hi Cammie,

>

> Thanks for your message. It looks like the biggest cost is the

hospital fee, because the

> Stanford hospital is so expensive and I don't imagine I could get

Dr. Riley to go to a

> different hospital to do the surgery.

>

> When you mentioned the cost, was that entirely out of pocket or was

that the total that

> was passed on to your insurance company? I want to try to see what

(if anything) my

> insurance company will cover. I just wish I could have a full

breakdown of the components

> and costs instead of (as it appears Dr. Riley's office wants me to

do) calling the hospital,

> anaesthesiologist, etc to get costs for each component, etc.

>

> Thanks,

>

>

[Guest guest]

And of course the hospital bill will depend on what kind of care you

need/receive (intensive care, or on a regular floor) and how many

days you're there -- as well as whether you have any complications

that require some special attention.

C.

>

> That was the bill from the hospital, which my insurance covered. As

a

> matter of fact, my wonderful insurance policy (provided mostly by

my

> kind employer) covered everything except the rental fee on a

suction

> machine my surgeon insisted that I take home. I never even opened

the

> thing up -- I was fortunate enough not to have any nausea.

>

> That is a nuisance to have to get separate quotes from each

provider.

> I would imagine that things are more expensive, generally, in

> California than they are here in Alabama.

>

> All my docs, and my hospital, were in-network, which no doubt

helped.

>

> C.

[Guest guest]

Hi ,

Welcome to the Twilight Zone episode called " Insurance nightmare " !

It is purposely made difficult to navigate in order to NOT pay for

your work. You will have to dig and dig, enlist the help of your

orthodontist and/or surgeon, and be persistent. When the insurance

denies you, and they frequently do, you will have to resubmit and

appeal. That is the way they work, or don't work. If you give up

during any part of this process - they win! They do not work for

you. Their job is to reign in costs, and if that means you pay for

your own covered procedure, that is 100% savings in their book. You

should be aware of that from the outset.

You will need to find your policy. And if your company is large,

your HR dept will probably have a medical specialist to help you

navigate somewhat. But your orthognathic surgeon will be very

helpful. The surgery itself is medical, so it will be from your

medical plan. The people in the surgeons office will basically know

what is covered and not covered. When a surgeon is out of network,

they will not know what is covered with your plan, but will know the

language to use to submit a letter to your insurance company. Some

surgeons offices will not do that. I would check to see how much

they will advocate for you before I would commit to a surgeon. That

means you have to work much much harder to get this going. That is

why for any surgery, I try to stay in network.

But when you check your policy, ask for the specific section of your

policy that relates to your need. Hopefully, they will share it

with you. But if you get " not covered " as an answer, do not stop.

That happens all the time. Keep plugging.

And good luck!

Fran

>

> I recently saw an oral surgeon, Dr. Riley (in Palo Alto),

and am considering having

> upper jaw surgery to correct my openbite/crossbite/class III.

>

> I finally decided to go ahead with orthodontics, but I have to

say, Dr. Riley's office has not

> been terribly helpful here. I called them and they wouldn't

really give me any information

> and told me to call my insurance company; they are not in any

insurance network.

>

> I have coverage through a large company with BlueCross (in their

PPO plan). I asked Dr.

> Riley's office if they could give me an estimate but they said

they don't deal with insurance

> companies, plans, etc...although I'm SURE they must have had

another patient who had

> BlueCross PPO.

>

> All I want to know is what I will be required to pay, out of

pocket, for this surgery. I have

> called BlueCross and they are almost entirely clueless---plus all

I can tell them is that I

> would be having orthognathic surgery of my upper jaw. They told

me to call the doctor,

> but the doctor tells me to call the insurance company. When I

asked about the hospital

> fee, the person I spoke with at Dr. Riley's office told me to call

the hospital. I mean this is

> really ridiculous that there is apparently 0 coordination here.

>

> Dr. Riley (when I met with him) indicated that the gross fees for

this surgery, including his

> fee + hospital fee, would most likely be upwards of $50,000 as the

hospital fee is $30,000

> per day. (ridiculous, in my opinion). If I have this surgery and

am stuck with a $50,000

> bill, I will not be thrilled nor financially capable of paying it.

>

> Is there some way to streamline this process to find out (a) if

the insurance company will

> cover anything, ( what they will cover, © what an approximate

out of pocket cost is?

>

> It would be really helpful if anyone from this area (Bay Area,

California) has gone through

> this with BlueCross PPO.

>

> Thanks so much,

>

>

[Guest guest]

Hi,

I live in Vancouver, Canada, and I just had a double-jaw surgery to

correct my underbite. The total fee I paid is CAD$4,000. I wonder

whether Americans can save money by having the surgery done in Canada?

humble_carp

> >

> > I recently saw an oral surgeon, Dr. Riley (in Palo Alto),

> and am considering having

> > upper jaw surgery to correct my openbite/crossbite/class III.

> >

> > I finally decided to go ahead with orthodontics, but I have to

> say, Dr. Riley's office has not

> > been terribly helpful here. I called them and they wouldn't

> really give me any information

> > and told me to call my insurance company; they are not in any

> insurance network.

> >

> > I have coverage through a large company with BlueCross (in their

> PPO plan). I asked Dr.

> > Riley's office if they could give me an estimate but they said

> they don't deal with insurance

> > companies, plans, etc...although I'm SURE they must have had

> another patient who had

> > BlueCross PPO.

> >

> > All I want to know is what I will be required to pay, out of

> pocket, for this surgery. I have

> > called BlueCross and they are almost entirely clueless---plus all

> I can tell them is that I

> > would be having orthognathic surgery of my upper jaw. They told

> me to call the doctor,

> > but the doctor tells me to call the insurance company. When I

> asked about the hospital

> > fee, the person I spoke with at Dr. Riley's office told me to call

> the hospital. I mean this is

> > really ridiculous that there is apparently 0 coordination here.

> >

> > Dr. Riley (when I met with him) indicated that the gross fees for

> this surgery, including his

> > fee + hospital fee, would most likely be upwards of $50,000 as the

> hospital fee is $30,000

> > per day. (ridiculous, in my opinion). If I have this surgery and

> am stuck with a $50,000

> > bill, I will not be thrilled nor financially capable of paying it.

> >

> > Is there some way to streamline this process to find out (a) if

> the insurance company will

> > cover anything, ( what they will cover, © what an approximate

> out of pocket cost is?

> >

> > It would be really helpful if anyone from this area (Bay Area,

> California) has gone through

> > this with BlueCross PPO.

> >

> > Thanks so much,

> >

> >