Re: Surgery costs (after insurance)

[Guest guest]

I think what that means is that no matter which doctor you use and

what you pay your doctor, your costs will be capped at $5,000 a year

(or $2,000 if you use in-network doctors and hospitals) - you will not

pay more than that. If they cover 60%, that means that the total of

40% that you pay will be less than or equal to $5,000. You might want

to call your insurance company and verify this though.

>

> Hello again, all.

>

> Does anyone know how the 'maximum out of pocket expenses' works? For

> example, if I go out of network, I am supposed to be capped at $5000 a

> year maximum for me ($2000 if in network). However, out of network

> stuff is also just paid at 60% of whatever the insurance companies

> considers 'reasonable'. So, how does this work? Is the doctor still

> going to make me pay what he wants, or does this mean the insurance

> pays for it all (even in this 60/40 situation) once I've done my $5000.

>

> Thanks...I'm confused.

>

> Cassie

[Guest guest]

Thanks, I sort of thought that is what it meant, but I'll give them a

ring to check as well.

For a possible $3000 total difference in cost, I think I should just

find the best doctor I can in Chicago, perhaps.

> >

> > Hello again, all.

> >

> > Does anyone know how the 'maximum out of pocket expenses' works? For

> > example, if I go out of network, I am supposed to be capped at $5000 a

> > year maximum for me ($2000 if in network). However, out of network

> > stuff is also just paid at 60% of whatever the insurance companies

> > considers 'reasonable'. So, how does this work? Is the doctor still

> > going to make me pay what he wants, or does this mean the insurance

> > pays for it all (even in this 60/40 situation) once I've done my

$5000.

> >

> > Thanks...I'm confused.

> >

> > Cassie

[Guest guest]

When figuring the percentage insurance may cover, be sure to find out what

the percentage includes. I have Blue Cross of Oregon. IF insurance deems the

surgery medically necessary, we would have a maximum $2,000 out of pocket

expense. Then, insurance would pick up 70% of the doctor's costs, but ONLY

on the portion considered " usual cost/customary rate " (about 30% of the

total).

Upper/Lower: $16,008

$8,498 (doctor costs)

$1,785 (insurance benefit)

Lower: $11,662

$5,081 (doctor costs)

$1,067 (insurance benefit)

I decided I didn't need this stress and took out a second mortgage. We'll

see what happens!

I get my spacers on March 7 and braces March 14...surgery probably in about

a year.

Diane

>

>Reply-To: orthognathicsurgerysupport

>To: orthognathicsurgerysupport

>Subject: [Orthognathic Surgery Support ] Re: Surgery costs (after

>insurance)

>Date: Tue, 01 Mar 2005 17:31:29 -0000

>