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Has anyone else ever had to pay 2 copays for their surgery?

I was just told today that I have to pay the hospital inpatient copay amount of $250...ok, kinda last minute but I knew there would be something....

Then I was told that $250 is for the inpatient at the hospital but my surgeon also expects $250...WTH? Is that possible, I've never heard of having to pay 2 copays for one procedure.

I pay my copay for the office visit, I don't then in turn pay the MA who does my blood work or the Dr. that diagnoses me.

I honestly wouldn't care what they wanted if my surgery wasn't on 4/23 and they are wanting these amounts paid by 4/16. That's kinda last minute to just hear about this now after the entire 8 months and finally getting approved and getting a date and now I'm in jeopardy...smh.

Just hope my husband can handle all this...I spent all my extras preparing for the big day and wouldnt have done such damage if I'd known...

Anyone ever seen this?

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I guess they should have told you earlier but .... $500 is a lot less then the $5000 + I will have out of pocket by the time I get my surgery and thats with having insurance really bad insruance ... but insurance none the less.

Edited by ready2getgoing

I'm guessing it's because everyone is billing separately. I was a self-pay, but I had to pay the surgeon and the surgery center separately. Just my guess.

It's not anything unusual. I have had many surgeries. I have always had to pay something to the doctor's office and the hospital. This time I shouldn't have to pay anything for my surgery, because my deductible and out of pocket have been met. I hope you get everything worked out and you have a safe surgery and good recovery.

very common, there are facility (hospital) charges and doctor (provider) charges that are billable separately... but I agree, someone should have, at least, MENTIONED that co-pay before you got to this level

I was lucky, my doctor let me pay after and as much as I could at a time

Good luck!

Yep - I had to pay $300 to my doctor and $300 to the hospital but they did tell me that at my initial visit so I was able to save up for it.

  • Author

Oh wow, so it sounds more common than I thought. I called member services and they say I pay 1 copay and that's to the facility. But the Dr. Is an outside provider so I guess they can be right too...this is so unfair.

I sure hope my Mfa goes into effect by then. They cover all copays and prescriptions...

If u have Kaiser, look into it!!

As part of my pre-approval process - I had an appointment with a physical therapist, an initial meeting with the nutritionist and getting my lab results from my bariatric doctor. All of these appointments were all in the same day and in the same hospital. I had to pay three separate co-pays. It was very frustrating.

It's not anything unusual. I have had many surgeries. I have always had to pay something to the doctor's office and the hospital. This time I shouldn't have to pay anything for my surgery, because my deductible and out of pocket have been met. I hope you get everything worked out and you have a safe surgery and good recovery.

I am a little concern myself Bc the sd I have $1000 deductible and 80% paid by insurance up to 2,000 max out of pocket includes the deductible ..smh not sure what that mean I have to pay???!

Your insurance will pay 80% after you meet your 1000 deductible. I am not sure if that 1000 is applied to your out of pocket. I have UHC Choice Plus and my deductible was met before anything was applied to my out of pocket. Your insurance person at the surgeon's office can explain it better than I can. Feel lucky that your out of pocket is only 2000 mine is 6000. They will probably be able to tell you what you will have to pay.

Edited by jtickle

Could be worse...you could be self employed with a $5000 deductible. Thanks Obamacare. NOT!

I was just told today that I have to pay the hospital inpatient copay amount of $250...ok, kinda last minute but I knew there would be something....

Then I was told that $250 is for the inpatient at the hospital but my surgeon also expects $250...WTH? Is that possible, I've never heard of having to pay 2 copays for one procedure.

I pay my copay for the office visit, I don't then in turn pay the MA who does my blood work or the Dr. that diagnoses me.

I honestly wouldn't care what they wanted if my surgery wasn't on 4/23 and they are wanting these amounts paid by 4/16. That's kinda last minute to just hear about this now after the entire 8 months and finally getting approved and getting a date and now I'm in jeopardy...smh.

Just hope my husband can handle all this...I spent all my extras preparing for the big day and wouldnt have done such damage if I'd known...

Anyone ever seen this?

Is it a copay or deductible. I'd double check with your insurance company. Both the dr and hospital will bill separately so it's not unusual to owe money to both providers. Do yourself a favor and find out exactly what your benefit is so you don't have any surprises.

  • Author

I am a little concern myself Bc the sd I have $1000 deductible and 80% paid by insurance up to 2,000 max out of pocket includes the deductible ..smh not sure what that mean I have to pay???!

This means after u pay ur deductible in full, u will then only pay 20% coinsurance which is just like a copay. So whatever the fee is for the service say it's $100 your coinsurance is $20 and that's up until u pay $2,000 max out of ur own pocket in a policy year, then they will cover all costs at 100%.

I'm actually a certified medical insurance specialist which is why I'm concerned that I didn't know u can pay double copays...smh...lol. You learn something every day, I'm still newly certified.

  • Author

Could be worse...you could be self employed with a $5000 deductible. Thanks Obamacare. NOT!

Damn! Smh...sorry to hear that...geesh!

Not sure if each state is different but I have had a couple of surgeries in the last few years and a couple months afterwards I usually would get a bill from the facility, from the surgeon, from the anesthesiologist as well as any from labs that they had to do. The lab ones are usually like $20 and the anesthesia ones are like $100-200. But I switched jobs this past August so thankfully my max out of pocket for this surgery is now only $500. Used to be $3,000. I too hate surprises, but I think what we all end up spending, for us it will be worth it :) Good luck with everything!!

  • Author

Ok guys, glad I did my homework...I called member services myself and I urge you all to do the same when it comes to the unforeseen fees from the Dr's office. So what they told me is...I have a $250 copay for my inpatient stay at the hospital and that I should not be forced to pay that inpatient fee for the surgeon's office also unless it was a standalone clinic and I was sleeping there. It's not, I'm going to the hospital.

Member services helped me greatly, they informed me that since I've paid my fee for the hospital, the surgeon's fee will be paid once the hospital has been paid and any remaining fees will be my responsibility but it looks like after I pay the copay, I am covered at 100%, so I am all good.

Luckily I had the staff call member services at Kaiser to tell her what I owe because she said she got her information from the guy at St. Agnes(the hospital) and he only quoted her what I owed them and she thought I pay them the same.

Just remember, you don't know the skill set of the person you are putting in control of your business, know when something is not right and ask as many questions as it takes until you have a full understanding.

I just got my apology call and I am more than forgiving and thankful that it's all cleared up but heed this head up warning!! Surgery is a go for 4/23 and I'm as ready as I will ever be to get it over with...lol.

Good luck to you all...

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