Re: Insurance questions

[Guest guest]

Talk candidly with your surgeon about this issue.

I don't know whether he can or will help. Or whether she has issues

with the approved anesthesiology team. If so, better to know it

ahead of time.

But your docs will have the best answers for your original case,

about this. I know my doc stopped doing surgery at one local

hospital because they would not let him choose the anesthesiologist.

Fortunately for me, the one he chose for me was the one I would have

chosen (I knew him from previous experiences), and everything was on

target.

You do want your team to be in consensus here. Best way of getting

that, I think, is to be candid with them about what's happening.

C.

> Hi Folks,

>

> Just found out about this newsgroup, and feels so nice to be a

part of the

> community here.

>

> I have my surgery scheduled in Sept....Upper, lower jaw to be

moved forward

> and genio...

> The quote from the doctor (including the asst. surgeon is almost

$30k.

> The doctor is out-of-network, and that means only 80% of the Usual

&

> customary reasonable charge will be covered by United Health Care

(UHC).

> Does any one have any experience with what UHC considers the UCR

for:

> Lefort I osteotomy, 1 piece (CPT, 21141) & Bilateral sagittal

Split Ramus

> Osteotomy (CPT 21196).

> I am really nervous about the variance b/w what the doctor has

quoted, and

> what the insurance would mark as UCR.

>

> While the hospital is in-network for UHC, the anestheosologist

they contract

> with are not. Apprarently, they accept charges equivalent to in-

network only

> when the OS is also in-network. They hinted that I can try

negotiating a

> discount (after I am billed)....since, I don't have the option of

choosing

> the anesthesiologist, is there any way, I can get to an 'in-

network' deal?

> Scares me at what I might land paying out of my pocket.....

>

> Thanks a lot,

> -Sriram

[Guest guest]

,

You've got a lot to consider. I can only help marginally and only about the oxygen. I went without insurance for nearly a year when I first moved here to NC. Duke's financial hardship program paid for nearly all my medical stuff but I paid for my own oxygen. I managed. It is possible.

I owned my own concentrator. This eliminates the monthly rental of this item which in my area runs around $75-$125 a month. If you buy a concentrator that you can fill your own tanks with this will also help. That's what I did and I only had to purchase additional tanks if I was traveling. My provider at the time charged $10 for D tanks and $14 for E tanks.

I would say you need to think very carefully though. If your O2 needs progress, the equipment that you've purchased might not meet your needs. What I did worked out fine for me because I stayed stable during that year. I would probably have a different attitude if things hadn't gone so well.

As I said, I don't know anything about your two insurance choices. But I think you're doing the right thing by gathering as much information as possible.

I'm sorry you're having to make these decisions. You know I love you to bits and pray for you all the time!

Beth

Moderator

Fibrotic NSIP 06/06 Dermatomyositis 11/08

To: Breath Support <breathe-support >Sent: Thu, February 4, 2010 8:04:19 PMSubject: Insurance questions

Hi Family!

Just checking in and need some advice. I just got the results from my latest PF tests and CT Scan and all I can say is this disease is really a roller coaster ride! According to the pulmonologist, my lung function is only marginally worse ( volume 52 %, DLCO 34%) but my lung structure is markedly worse. He has decided against putting me back on prednisone but feels that with or without it I am looking at transplant in 2 to 3 years. I know that it is the same for all of us but I feel that every test comes with "You need a transplant" and in between tests he says " I think you may not need a transplant." The only consistent is "You are slightly worse"lol .

Sooo, on to the advice part. My COBRA insurance just ended and I now qualify for HIPPA. My two best choices are Kaiser for a whopping $555 a month or Aetna for $535. Aetna is a PPO and I can stay with UCSD , but I would have to pay for my oxygen out of pocket. Kaiser would cover the oxygen but my eventual transplant would be at Kaiser. This is my only oportunity for insurance and whatever I choose will have to be my plan for life since no one will willingly insure me. Because I was a teacher I do not qualify for SS or medicare. I have to decide quickly because right now I am uninsured and I have to pay cash for all medical expenses. Does anyone pay for their own oxygen? Does anyone know of someone who had a transplant at Kaiser? Any advice? Thanks in advance for your imput-

R. (54) Sarcoid/PF 3/2006 Carlsbad, California