Insurance Approval !

[Guest guest]

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