Re: I need some help..(kinda long)

[Guest guest]

Liz-

Would you please tell me the code numbers?

Lynn

-- In duodenalswitch@y..., lnielsen@c... wrote:

> Thanks, Chris..

>

> I was not aware that when Doc's are not in network, they require

100%

> upfront. Is it just that they never get paid? I am just shocked

> that peeps can afford this on their own. If I have to pay for it

> myself I might as well go to Spain and have a vacation out of it

> too.

>

> Also, I was under the impression that none of these doctors are in

> network.. I guess that is false??

>

>

> > > Well, I got approved for my surgery--WHOOP! Now I am entering

> the

> > > daunting phase of figuring out how much my insurance company

will

> > pay

> > > the doctor's office. If I cannot get specific figures, I have

> been

> > > told by Joanne at Dr. Rabkin's office that I will need to pay

for

> > > everything in full and *I* will be the one to get reimbursed

from

> > the

> > > insurance company.

> > >

> > > This is what I have been able to get so far. I have a 20% co-

> > > insurance up to $1000 per year, plus a $300 deductible. I have

> met

> > > my deductible for the year and a small part of my co-

insurance.

> I

> > > have been given a letter from the Guardian that states the CPT

> > codes

> > > (supplied by the Doc's office) and the Doctor's charges for the

> > codes

> > > but NO specific amounts. My insurance will only pay what is

> > > reasonable and customary for the procedure and the area. Four

of

> > the

> > > six codes are reasonable and customary, 2 are not and they are

> the

> > > big ones. I have been told that insurance companies will not

> give

> > > out specific numbers due to insurance fraud. I can understand

> > that,

> > > yet why in the heck do I pay insurance only to have to turn

> around

> > > and self-pay and wait to get reimbursed? I am frustrated.

> > >

> > > Now, I have also been told by Joanne that I will not get a date

> for

> > > surgery until they have recieved a 'disclosure of legality' or

> full

> > > payment from me. Has anyone else been told this? I do not

> > > understand why this is so difficult. I really need some advice

> and

> > > anything you can impart on me will be so appreciated.

> > >

> > > Thanks in advance!!

> > > Liz