insurance costs this is ofr and other Kolb pts

[Guest guest]

I am curious, you say you paid 14,000 for your surgery, Does this include

her after care program too, or is that seperate? Also there has been so much

talk about her after care program, can someone who went to her please tell

us what exactly it consists of? Maybe if we were more aware of what it all

involves there would be less question about her prices. I am also sure she

must charge less when paid in cash. I had a friend who went to Kolb about 3

years ago and she told me she paid $9,000. She had a lift too, and she said

she did not buy any of the supplements cause she got them cheaper where she

lived in New York. Anyhow I am curious about this email because I am the

first to admit insurance is not one of my specialty areas. In fact I steer

away from it and hate it in my work, so I never dealt with it much at all.

Please explain to me why they charge more to insurance companies, is that

not gouging th companies? No wonder most of us cannot get these surgeries

covered! Maybe I am wrong though, that is just how it seems to me. I still

think $14,000 is really too much that is why I am so curious if she has a

different price for self pay and also if she includes her after care program

in her price.

PS don't get me wrong, if people want to pay that much I have nothing

against it, I mean everyone has always been telling me I paid too much too,

but I just followed my gut with what felt right, when your so ill you have

to do that.

thanks for the info and take care

C

----- Original Message -----

From: " jean_puppe " <jpuppe@...>

< >

Sent: Tuesday, November 12, 2002 10:45 PM

Subject: Re: insurance costs

> 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.

>

>

>