Re: Insurance Approval !

[Guest guest]

Hi Diane,

I am in the same situation with my surgery. I will be having the

surgery in the hospital with Dr West as it also helps me. It amazes

me at insurance that they set things up which actually cost them

more, in an effort to put more of the cost on the beneficiary. It

mkes little sense.

The woman in Dr West's office (sorry I can't remember her name) is

very good with insurance issues like this. She was able to tell me

pretty much what my insurance would pay based on what it had paid

for other subscribers in DH's plan. If you call and ask for the

medical insurance specialist in the office, I am sure she could tell

you up front what to expect.

But hey, you are getting there! This is definately closer!

Hugs,

Fran

> BCBS of Oregon approved my surgery today! At first I was really

> excited. That was until I looked into what this meant in terms of

> dollars.

>

> It's estimated my surgery (lower and upper, bone graft from hip)

> will cost $16,008. Given the estimates some of you have had, I am

> thankful for that estimate. I'm having surgery in late-Fall by Dr.

> West, Seattle, Washington, who is a non-participating member of

> BCBS. The BCBS representative said the highly regarded

> doctors/specialists can get away with not participating in a

medical

> plan. This way, they don't have to write off the difference the

> insurance company won't pay.

>

> Of my three procedures, insurance will cover 70% of their " usual

and

> customary services " ; not 70% of the bill. All totaled, it looks

like

> BCBS will cover just over $4,000. I have a $1,000 maximum out of

> pocket expense, but anything over what the insurance company won't

> pay is my responsibility.

>

> Once the surgeon receives my insurance approval, they'll work with

> me to try and break down my costs. I was going to have the surgery

> in the surgeon's medical facility (cheaper), but the facility

isn't

> a participating PPO either. However, I could have the surgery at

the

> Swedish Medical Center (hospital), which is a PPO. Although the

cost

> for the hospital would more than double what it would cost to have

> the surgery at the surgeon's facility, my benefit amount would be

> 85%. Thus, it could be cheaper for me to have the surgery in the

> hospital.

>

> Those of you having your surgery with Dr. West, have you decided

> whether to have the surgery in their surgical facility or the

> Swedish Medical Center?

>

> OY...I have more questions than answers at this point. But, $4,000

> is better than nothing. In fact, it just about pays for my braces.

>

> Best to everyone.

>

> Diane, Oregon

[Guest guest]

Diane, I have the same problem. My OS is a non-participating

surgeon, so they allow even less the if he as participating. And

then theyonly allow 70%. I'm still waiting to see my total amount

for surgery. I had to pay about $6000 upfront.

I'm not worried about the hospital as they are a PPO, so they will

take whatever BCBS allows and write off the difference. And my

secondary insurance should take up the part BCBS doesn't pay. Also

with surgery I should be hitting my catasphoric (sp) limits, so

we'll see if they pay a 100% after that.

The hosptial has already billed BSBS for my two night stay (1 night

in ICU) for $28000. Now to see how much I owe the surgeons. That's

the one I really worry about. I've decided I will appeal any

decision. My surgical splint cost $2000 and BCBS allowed only $888,

and paid $600.

I'll let everyone know how all turns out costwise.

Shirley