Bills After Insurance

[grammyto2 8]

$10,000.00 max lifetime, $2,000.00 ded., $300.00 hospital, $35.00 co pay per visit specialist, and 90/10, also in network only....so how does one end up with hospital bill of $22,000.00 (remember they're in network also) for vsg after already paying surgeons $2,000.00 out of pocket, and being approved by Bcbs ga

a friend had this surgery and this is the bill from hospital...I too share same ins. And this makes me uneasy....

[pebbles99 10]

i only recently started having insurance, but i was told by them 9oxford) that i would only have to pay the deductible with is $3,500 (for the hospital) along with the co-pays for my 6 monthly visits prior to my surgery (scheduled for 8/6). if everyone is in network, it should be 100% coverage. Something must be wrong.

[chitowngirl 884]

It's the 10k life time max. My insurance paid 32k for my procedure.

[AliveAgain 283]

What is the $10,000 max lifetime? Do you mean "out-of-pocket maximum"? There could be a number of things going on:

• They haven't been fully reimbursed by insurance, so the bill was sent on a cycle before it shows the adjustments and payments? (This has happened to me before).
  
• There is a difference b/n the fee surgeon's charge for "uncovered" services and then what they charge the hospital. They should have explained this to your friend before surgery.
  
• Most hospitals offer a financial screening before your surgery to tell you what the estimated charges will be and how much you will most likely owe. Mine did this, and then they offer a discount if you pay that amount up front THEN let the insurance work out and bill/refund the difference. I think mine said my portion would be something like $1200 and they gave me a 20% discount; once all was run through Anthem BC, I actually got a refund of $200.
  
• It could just be that after the deductible plus other co-pays, that the percentage left over (of the 90/10) was close to $20,000. I checked into the hospital at 8am and was discharged the next day at 5pm. I had one overnight stay, no complications, no tests run (CT, leak, etc.) Just your basic bed, IV fluids, hooked-up to machines, monitored by nurses, blood drawn periodically, etc. and the total charges billed were something like $112,000 for the hospital. The anesthesiologist is a separate service, and he was $2000. Thankfully I have a $1500 out-of-pocket maximum, so once I hit that number everything went from 90/10 to 100% covered. Had it been a higher number, then upwards of 10% of the "write-off" amount would have been mine to pay, somewhere around $5500.
  
• Are there any exclusions to the 90/10? Sometimes labs, diagnostics, durable medical equipment do not qualify or qualify at a different rate (like 50/50).
  

[chitowngirl 884]

The 10k life time max is the maximum amount of coverage your insurance will pay for the life time of the policy. Some policies have calander year max and some have life time max. There is no way to appeal that it is a coverage issue it is not a denial, your insurance won't cover a cent more. I'm suprised that the facility even did it knowing that you had you have such limited coverage.

[grammyto2 8]

I thought the hospital would be the $300 x 2nights=$600 then the 90/10 under hospitalization part and the surgery under the bariatrics max life amount of $10k. All other tests and procedures under the 90/10 plan and ded., and max out of pocket is $2000 but not bariatrics. Ins. is so hard to figure out...requires a college degree!! Ughhhh

[AliveAgain 283]

Yes, insurance is a pain in the tukas. Do as much prep work as you can up front, and ask a LOT of questions. Hospitals do offer financing as well, if it something you can do.

[grammyto2 8]

Emlefe you are 100% correct with your information thank you! And my friend does owe that amount after surgery unfortunately. I think IMHO the ball was dropped somewhere along the way and that she should have had a better understanding herself as well as from surgeons, coordinators,hospital, etc...on the over all expense out of pocket! And thank all of you for your input.

I'm considering Mexico as an option, so researching starts all over. Any thoughts about Mexico?

[Gastricsleeve4me 186]

Emlefe you are 100% correct with your information thank you! And my friend does owe that amount after surgery unfortunately. I think IMHO the ball was dropped somewhere along the way and that she should have had a better understanding herself as well as from surgeons' date=' coordinators,hospital, etc...on the over all expense out of pocket! And thank all of you for your input.

I'm considering Mexico as an option, so researching starts all over. Any thoughts about Mexico?[/quote']

Personally? Don't hesitate. I skipped the insurance drama even though I had it and couldn't be happier with my decision. If you check out the Mexico forum you'll find lots of others like me, and lots of others like you cnsidering it!

[IMSKINNY 160]

Personally? Don't hesitate. I skipped the insurance drama even though I had it and couldn't be happier with my decision. If you check out the Mexico forum you'll find lots of others like me' date=' and lots of others like you cnsidering it![/quote']

You're right! Although I would like to be approved by my insurer, I have already set in motion surgery in MX in the month of August! One way or another, it's getting done!

[grammyto2 8]

I appreciate your views on Mexico, and support. Thank you! And now I'm heading over to the forum mentioned!

[IMSKINNY 160]

I appreciate your views on Mexico' date=' and support. Thank you! And now I'm heading over to the forum mentioned![/quote']

Ask for the names of people that the surgeon from MX has operated on that you can talk to personally. That's what convinced me!