Re: insurance costs

[Guest guest]

, just had to add another comment on the price situation, it drove me up a wall today! I went back through all my notes with Dr. Feng and also Dr. Kolb, and I wanted to share with you, and the group what I did find. First of all, Dr. Feng's prices are not a flat rate when it comes to insurance pay , (like in my instance) only self pay. Maybe when you saw her , but not from my notes, and estimates from her office for me. First of all, self pay rates, and insurance rates are completely different. (I have worked with Farmers ins. for over 8 years, and am familiar with health plans, and claims.) With the self pay, you have to pay the amount or partial up front, to cover the whole surgery, so there is no loss to the doctor whatsoever. If they go over in time, they usually have no recourse but to ask you to pay the rest, or leave it be. (Usually the later case) With insurance pay, the doctors office will bill the insurance, and in almost all cases, there is a cap out amount on each service, such as the explant, and also on the OR & anesthesia, and they will never get the full amount of the entire surgery. As in my case, my insurance did not cover the full $12,000, (I found a statement from last week) only about 65% of that, as that was their cap out amount for explant. So therefore, their are some doctors that will not go with certain companies, as they know they will only cover say $8,000 for an explant, out of a total of their claimed $12,000. Dr. Kolb accepted mine, and knew full well she would not receive anywhere near the final amount. Which really was a covered amount of $8000 total. Although they agreed to cover explant, they have to draw the line at what cost is their cap out. With mine, it was 8000. Also, because Dr. Feng was out of network, I would have to come up with the entire amount to go ahead with surgery. If Dr. Feng was covered by my insurance, I guarantee that her price is not a flat rate-because when it comes to billing by insurance, insurance always bills the Or facility, and anesthesia based on time only. So, if they go over, there are more charges and fees.

Also, , please check into it, but I was quoted with a breast lift at $4,000 (and so was a friend of mine two weeks ago) needed up front with Dr Feng, while it was $3500 with Dr. Kolb, and remember, I received back almost 1,000 from Dr. Kolb.. So my lift was only $2500.00. Both of their prices are very similar. I don't mean to rehash things, I just thought I should share the prices I have in front of me, and explain the ins thing, so there are no misunderstandings. I am not saying by any means that Dr. Feng was not a wonderful surgeon for you, I just went crazy when I heard someone was quoted $14,000 from Dr. Kolb, because that is not true. To be honest with you, that price suddenly came up about two days after someone asked me what my bill was for a 7 hour surgery. She must have misunderstood. And then all this talk got me researching, because I realy always thought they were very similar from the start, there was just a problem with ins & $$ with Dr. Feng. So, that is what I found.

Dr. Kolb is no more higher, than Dr. Feng, and actually, I got money back on my lift. Hope this helps.

[Guest guest]

Hi ,

I just wanted to share my recent 'costs' and insurance info with my

explant I just had with Dr. Kolb. For the 3 hour surgery, I was

quoted $13,000. It lasted 4 hours, so I assumed it would be a

little more. Dr. Kolb IS in my network thank God...so my insurance

did pay. What amazed me is what their agreement is for the dollar

amount to be paid for this procedure. To date I have received 2

explanations of Benefits from my insurance company. The first bill

was Dr. Kolb's bill...a total of $5,000. This is the amazing part.

Do you know what amound was paid to her? $867.00. I am not

kidding...that is the amount she got paid from my insurance. My 15%

of that was $153. That had already been paid. The other bill is

for the Surgery Center. The billed charges were $7,702.36. The

eligible payment amount was $3,928.20. Again, my responsibility was

15%, or $693.21. Those are the two big bills...and I imagine I will

be getting something from pathology as well. AND...I have already

been told I will be getting a refund from Dr. Kolb because I paid my

full deductible ($600) AND my max. out of pocket ($1400) before

surgery. This was determined because of the cost of the

procedure..so it appeared that I had to pay all of it. But

obviously, it didn't 'cost' that much because of the Provider

Contract Discount...so a refund will be issued to me from her. My

point is...I am AMAZED these Dr.'s agree to take some of these

insurance companies on as part of their accepted plans. I agree

with you...$14,000 is ALOT of money for this. But I was totally

flabergasted to see that Dr. Kolb received a mere $867.00 out of the

$5,000 bill. I would be the first to agree that 4 hours of

operating on someone should be worth more than that...but that is

just my opinion. So, you see, I also was told that my explant

operation would be close to $14,000..and it was...except she was in

my network and had to abide by the Provider Contract

Discount..therefore settled for less money. I just thought I would

write about what my recent experience was like.

> , just had to add another comment on the price situation, it

drove me

> up a wall today! I went back through all my notes with Dr. Feng

and also Dr.

> Kolb, and I wanted to share with you, and the group what I did

find. First of

> all, Dr. Feng's prices are not a flat rate when it comes to

insurance pay ,

> (like in my instance) only self pay. Maybe when you saw her

, but not

> from my notes, and estimates from her office for me. First of all,

self pay

> rates, and insurance rates are completely different. (I have

worked with

> Farmers ins. for over 8 years, and am familiar with health plans,

and

> claims.) With the self pay, you have to pay the amount or partial

up front,

> to cover the whole surgery, so there is no loss to the doctor

whatsoever. If

> they go over in time, they usually have no recourse but to ask you

to pay the

> rest, or leave it be. (Usually the later case) With insurance

pay, the

> doctors office will bill the insurance, and in almost all cases,

there is a

> cap out amount on each service, such as the explant, and also on

the OR &

> anesthesia, and they will never get the full amount of the entire

surgery.

> As in my case, my insurance did not cover the full $12,000, (I

found a

> statement from last week) only about 65% of that, as that was

their cap out

> amount for explant. So therefore, their are some doctors that will

not go

> with certain companies, as they know they will only cover say

$8,000 for an

> explant, out of a total of their claimed $12,000. Dr. Kolb

accepted mine, and

> knew full well she would not receive anywhere near the final

amount. Which

> really was a covered amount of $8000 total. Although they agreed

to cover

> explant, they have to draw the line at what cost is their cap out.

With mine,

> it was 8000. Also, because Dr. Feng was out of network, I would

have to come

> up with the entire amount to go ahead with surgery. If Dr. Feng

was covered

> by my insurance, I guarantee that her price is not a flat rate-

because when

> it comes to billing by insurance, insurance always bills the Or

facility,

> and anesthesia based on time only. So, if they go over, there are

more

> charges and fees.

> Also, , please check into it, but I was quoted with a

breast lift at

> $4,000 (and so was a friend of mine two weeks ago) needed up

front with Dr

> Feng, while it was $3500 with Dr. Kolb, and remember, I received

back

> almost 1,000 from Dr. Kolb.. So my lift was only $2500.00. Both of

their

> prices are very similar. I don't mean to rehash things, I just

thought I

> should share the prices I have in front of me, and explain the

ins thing, so

> there are no misunderstandings. I am not saying by any means that

Dr. Feng

> was not a wonderful surgeon for you, I just went crazy when I

heard someone

> was quoted $14,000 from Dr. Kolb, because that is not true. To be

honest with

> you, that price suddenly came up about two days after someone

asked me what

> my bill was for a 7 hour surgery. She must have misunderstood.

And then all

> this talk got me researching, because I realy always thought they

were very

> similar from the start, there was just a problem with ins & $$

with Dr. Feng.

> So, that is what I found.

> Dr. Kolb is no more higher, than Dr. Feng, and actually, I got

money back on

> my lift. Hope this helps.

[Guest guest]

That would certainly be my understanding...wouldn't you agree? I

know when I was having trouble with my insurance company to get them

to approve this...it was getting down to the wire as far as time

goes. I was told if the insurance company did not get the approval

letter to Dr. Kolb's insurance department on time, then I would have

had to pay $13,000 out of my own pocket...and then collect from the

insurance company after the surgery when the claim was

processed...and any over payment would also be reimbursed to me at

that time. It's crazy isn't it? Maybe that's why the self pay is so

high...because if they are involved in a PPO...they don't get a

heckuva lot for their time. It is really amazing to me.

> So are you saying that Docs charge more for self pay than for

insurance pay? So is this meaning that Kolb charges more that 13,000

for explant if people pay cash? Man that seems really high to me!

> ----- Original Message -----

> From: e Rene'

>

> Sent: Tuesday, November 12, 2002 9:57 PM

> Subject: Re: Re: insurance costs

>

>

> Martha,

>

> So what are you trying to say Martha? I have the written

estimates from Dr. Huang if you don't believe me. She does charge

more for self pay, as does most any doctor, but with insr

contractual agreements, the surgical fee is much less. Her price

has gone up in the almost 2 yrs since I've had my explant, but

doesn't every docs price go up? Absolutely. She charged the insr

company $3500; however, I had an excellent HMO that paid in full.

What the contractual write off was, I don't know. What I do know is

that she billed the insr company $3500, and I never saw any bill

from her. She is by far one of the cheaper doctors out there doing

explant---regardless of what your opinion is. I'm the one who had

my explant done by her; and I'm the one who asks for a written

estimate every 6 months! And yes, you're absolutely right. The

total cost can vary from surgeon to surgeon. What doesn't change is

the surgical fee, regardless of time spent working on you. What can

and frequently does change, and which can make your total cost for

this surgery (or any surgery) change is anesthesia time, OR time,

additional labs, tests, etc. Unless you happen to get an

anesthesiologist and surgical facility that doesn't charge per

minute, then that is usually what jacks up the cost of surgery.

>

> e

>

> ----- Original Message -----

> From: MARTHA

> Sent: Tuesday, November 12, 2002 2:54 AM

> @y...

> Subject: Re: Re: insurance costs

>

> Dear LM,

>

> You simply " just do not 'get it' " ! There is going to be a

certain 'price range' for each & every woman needing explant

surgery. Insurance coverage factors into the cost, the surgeon's

schedule load at any certain time is another factor; as well as if

you are having to pay total cash, or if insurance will pay

a 'reduced amount' because the surgeon is not in your insurer's PPO

group. The final one that makes perhaps the largest difference, is

the fact that medical personnel are entitled to, and

receive, " Professional Discounts " ! With this sugery,

the " Professional Discount " makes a significant difference in your

charges --- with, or without insurance coverage.

>

> So, first of all, you can all totally 'rule out' any

consideration regarding the amount e paid, to whatever doctor

she used!

>

> I am really frustrated with all the 'confusion' many of you

are causing on this site. If you cannot sincerely help by giving

totally accurate information; then quit providing 'helpful uplifting

information' that only leads to serious " let-downs " for many women!

>

> Seriously,

> MM

> Martha Murdock, Director

> National Silicone Implant Foundation | Dallas Headquarters

> " Supporting Survivors of Medical Implant Devices "

> 4416 Willow Lane

> Dallas, TX 75244-7537

> ----- Original Message -----

> From: perlesetlacet@a...

> @y...

> Sent: Tuesday, November 12, 2002 12:59 AM

> Subject: Re: Re: insurance costs

>

>

> :

> I think you really need to calm down and get hold of

yourself. I think 14,000 is too much money to pay to be explanted

BFD it's only MY OPINION!!! Why are you threatened by my opinion?As

for mentioning the 14,000 (and telling me I'm slamming your doctor)--

I never named your doctor's name--you did--which is what makes this

all the more laughable.I simply posted to the group that this price

was out there so beware. Then e and I suggested folks to go to

Huang because LIKE IT OR NOT, not all women can pay that kind of

loot even if the surgery is performed by the top in the land.To

think that all women can afford an expensive PS is to be living in a

fool's paradise. As for Feng charging a lot--she does and in MY

OPINION even 10,000 is too much. BUT I have great respect for Feng

and her work (because she's earned my respect and admiration) though

I wish she would come down on her price. There you went again with

more " assumptions. " I have told I think Feng's expensive! way

befor you joined this forum -- but she RESPECTS my opinion.

>

> As for the money thing again, Dr. Huang and my PS would

never charge this much and I think women have THE RIGHT to know this

BEFORE THEY DECIDE to be explanted/lifted. Do you have something

against free speech? Evidently so.

>

> In 1998, I paid 6,500 for a mastopexy straight out of hell.

Had I known I could pay less and have had a good job done on top of

it, believe me, things would be better for me today. I'm GLAD when I

hear debate on PS choices--it sure makes folks THINK before they

make an irrevocable choice. Choice is something I feel strongly

about and if you don't agree with me, that's just too bad. Once

you've gone under the knife, there's no looking back.

>

> As for my opinion on anything here, I have a God given right

to it, as do you. I also have friends who are former members of this

site so don't tell me about your assumptions of what I see and don't

see/know.And as for e-mails I have received concerning prices or

anything like that, I'll have to seek permission of the author

before making them available as I am familiar with copyright laws. I

will say this much, a mutual friend quoted me the 14,000 price. I

find this price appalling and if you don't agree, that's certainly

YOUR RIGHT.

>

> Lastly, I am glad your experience has been a good one. But

please, if you don't like what I have to say--delete my posts and

don't bother reading them--it's really that simple.

>

> Have a good night.

> LM

>