Guest guest Posted November 16, 2001 Report Share Posted November 16, 2001 > you what I understand. Dr. Hess requires $2500 upfront for surgical fees for > BC/BS patients. He does not participate in any insurance PPO. He does this > because then they decide how much he has to accept for the procedure. Also, > when a doctor is contracted the insurance company keeps close tabs on how > long hospital stays are for that particular doctor and will try to pull the > contract and such as they don't feel the doctor is being most cost effective > for them. My understanding is that Dr. Hess will accept $2500 + whatever the > insurance pays for the surgical fees as long as it comes to about $5000. That is how it was explained to me. In my case, BCBS approved me right off the bat, but at a lower benefit level, Standard = 80%, because it was out-of-network. Because no on in my network does the BPD/DS, I was going to fight that, but then I discovered that either way, my out of pocket limit was $2500....so it wouldn't have mattered anyhow. All I am on the hook for is $2500, which I would have had to pay Dr. Hess anyhow. I have also heard that if you can get BCBS to itemize in writing what they will pay, and it comes out to at least $5000, Dr. Hess might let the fee slide. Good luck getting BCBS to do it, though! Quote Link to comment Share on other sites More sharing options...
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