Re: Reasonable and Customary fees - Help

[Guest guest]

Thanks for the info Chris. I actually have indemnity insurance. I

pay 20% and they pay 80%. I am able to choose any doctor anywhere.

I have all the approval from them. I knew they would only pay

reasonable and customary fees, but comparing Dr. fees to

others I felt he was in the range of other Docs, cheaper than many.

They have sent the operative report out for review, I am hoping after

another look they will pay my Doctor more.

Thanks,

> > Hi

> >

> > After researching surgery for a year, fighting insurance, hiring

> > Walter Lindstrom and then finally having to change insurance I

got

> > approval and went ahead and had a DS on 6/12. I just hung up

from

> my

> > insurance company CoreSource and they advised me they only paid

> > 3,484.12 towards a bill of 12,146.00 based on reasonable and

> > customary fees. They said they may pay more once they review the

> > operative report. According to my bill I had a Biliopancreatic

> > (4750.00), Gastrectomy (3364.00), Appendectomy471(1432.00) and a

> > Enteroenterostomy (2456.00) It looks to me that the insurance

> > company only paid against the Gastrectomy. Any thoughts on this,

> has

> > anyone else had to fight this battle? I expected to have to pay

> > something due to resonable and customary charges, but I did not

> think

> > they would only pay 1/4 of the bill. This would leave me 8600.00

> to

> > pay, I think that is extreme.

> >

> > Thanks,

> >

> > DS - Dr.

> > 6/12/01

> > -50 lbs.

[Guest guest]

In a message dated 9/5/2001 12:01:33 PM Pacific Daylight Time,

terjer1976@... writes:

> From what I understand, some hospitals refuse to " write off " the difference

> and the patient is stuck paying the difference.

>

I asked and it depends on the contract...my hospital here in Bellingham has

to write off the difference...so if I have to pay 20% of the bill...and the

insurance only says they will pay 1000...then I only have to pay 200 even if

the bill was like 2000. If I went out of network or only a participating

hospital...I might end up paying the difference....makes alot of difference!!!

~*~ AJ ~*~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 415.1

08/06/01 BMI 59 390.2 -24.9 lbs!

08/16/01 BMI 58 387.0 -27.9 lbs!

08/24/01 BMI 58 386.5 -28.6 lbs!

08/30/01 BMI 58 378.3 -36.8 lbs!

[Guest guest]

From what I understand, some hospitals refuse to " write off " the difference

and the patient is stuck paying the difference.

Jerry, southern gal from Louisiana still waiting on approval

>From: lookn2bthin@...

>Reply-To: duodenalswitch

>To: duodenalswitch

>Subject: Re: Reasonable and Customary fees - Help

>Date: Wed, 5 Sep 2001 01:30:39 EDT

>

>In a message dated 9/4/01 8:41:41 PM Pacific Daylight Time,

>alyssaj@... writes:

>

>

> > According to my bill I had a Biliopancreatic

> > > (4750.00), Gastrectomy (3364.00), Appendectomy471(1432.00) and a

> > > Enteroenterostomy (2456.00) It looks to me that the insurance

> > > company only paid against the Gastrectomy. Any thoughts on this, has

> >

> >

>

>Chances are they paid a little on everything....if you ever look at the

>benefits explanations you get for anything medical...they show what was

>charged and what was paid. My insurance for instance then requires them to

>write off the difference. Some things they pay 100% but that is on their

>scale...not the dr's scale. I'm sure when you do multiple things, they

>have

>some table they use and it tells them what percent to pay. They have to

>make

>it as complicated as possible and it seems the hospitals do better getting

>a

>higher precent than the drs.

>

> ~~* AJ *~~

>Age 37 5'8''

>Post op 7/24/01 Open BPD/DS

>self pay - Dr Baltasar -Alcoy Spain

>07/24/01 BMI 64 415.1

>08/06/01 BMI 59 390.2 -24.9 lbs! -10.75 inches

>08/16/01 BMI 58 387.0 -28.1 lbs! -11.25 inches

>08/24/01 BMI 58 386.5 -28.6 lbs! -15.5 inches

>08/30/01 BMI 58 378.3 -36.8 lbs! -21.25 inches

>

>My personal website: www.WLS4AJ.homestead.com

>

>Check out the Bellingham Support Group at

>WWW.WLSBellingham.homestead.com

>

>

>