Finally got cost estimate -- uh-oh

[Guest guest]

Well, i had a roller-coaster ride as far as finding out how much

this thing is going to cost:

Yesterday, my OS called me to tell me that my insurance company had

pre-approved coverage the surgery (hooray, right...? well, just

wait...)

Today, however, they called me back and told me that my coverage

only gets me 50% coverage out of network. Add that to the fact that

the insurance co's " usual customary rate " for this surgery is 33%

lower than what the OS is actually charging, and it looks like I'm

being left on the hook for about $23,000 on this thing. (I'm

getting both upper and lower done, at a cost of $18,000 EACH;

insurance co is covering 50% of their UCR which is about $13,000

each, so they're paying a total of $13,000 of the $36,000).

So a few questions:

a) I have absolutely no basis for comparison...do these figures

sound at least in the realm of reasonableness?

Do I have any wiggle room here, either with my insurance co., or

my OS?

c) My insurance plan clearly stated that my yearly " out of pocket

maximum " was $2,000 -- I took that to mean that no matter what

medical expenses I had during this year, in no case would I be out

of pocket more than $2,000...now I'm being told that that actually

isn't true at all...that " out of pocket maximum " actually means

something else, and there's no reason to think I won't be on the

hook for this entire $23,000. Anyone have any insight on this??