Shirley/Re: Insurance - Amount Allowed

[Guest guest]

Hi Shirley,

My OS and asst. OS are also both non-participating. Care First has

allowed $960.00 of the $1,750 asst. OS fees. I am still waiting to

see how much they are going to allow of my OS total fees of $7,500.

My original pre-workup/splint fee of $2,750.00 was at first denied

and is now under appeals with the insurance company. My doctor had

to submit more paperwork to them which has been done. It's funny

because the surgery was pre-authorized which you would think they

would of already had all the necessary models, pictures, etc. needed

for pre-authorization.

Anyway, I will keep you posted on how much of my OS fees will be

allowed as soon as I get word from the insurance company. My total

hospital fees was 25,000 and so far only $9,600 of that has been

allowed. The hospital is also sending the insurance more paperwork

to hopefully approve the remaining charges.

--Caboose

>

> Hi All, I am trying to appeal what my insurance has paid. I'm just

> curious as to what others have found as allowable charges for

Lefort

> I, BSSO, genio. The turbinectomies they are not allowing at all,

> yet they were necessary to open the airway up. (Surgery was for

> sleep apnea)

>

> My surgeon & asst. surgeon were non-participating, though I was

> referred from a participating physician (pulmonologist).

>

> The charges and what my BSBS (Federal Employees) allowed follows:

>

> Lefort 1 Surgeon, $5700 Allowed: $1236.90

> Asst Surgeon, 1425 Allowed: 1236.90

> BSSO Surgeon, 5510 Allowed: 1323.44

> Asst Surgeon, 1800 Allowed: 1440.00 (seems out they would

> allow more for Asst. than Surgeon)

> Genio Surgeon 5300 Allowed: 968.24

> Asst Surgeon 1325 Allowed: 1060.00

> Turbin. Surgeon 1150 Allowed: 0

> Asst Surgeon 287.50 Allowed: 0

>

> Of course the total was $22497.50, I already paid $6000, and the

> amount they have paid so far is about $10,000.

>

> I would like anyone input on what they're OS charged and what their

> insurance companies allowed.

>

> Thanks for your help.

>

> Shirley

>