October 15, 201411 yr Ok, so my surgeon's office and my insurance company haven't mentioned anything about when my deductible is due. Do most people have to pay before surgery or get billed later?
October 16, 201411 yr I have a $2000 deductible and $2500 maximum out of a pocket, which totals to $4,500 before my insurance picks up all. As of now, my deductible is met, but only about $160 of my OOP is met. I've already paid my surgeons office for the surgery, so I'm guessing the bills I get from here forward will be a hospital bill, anesthesiologist bill, and I was told that I would get a separate bill from another doctor that assists my surgeon during surgery.
October 16, 201411 yr Because its first come first applied. You can meet your deductible doing all the pre op care and surgeon never gets it. My $4500 was met by my EGD and other preop care. My kids met $1500 in out of pocket - ER events- The next 3000 of $4500 oop max more was met by hospital where sleeve was done and then I am done. Surgeon, anesthesia and post op all covered 100% Now I just have to wait for the bills and work out payment arrangements
October 16, 201411 yr I had two colonoscopies and two ct scans and two er visits this year. My max out of pocket was met a while ago. My bariatric should be free. I say should because insurance companies like to play games.
October 16, 201411 yr I have a $2000 deductible and $2500 maximum out of a pocket, which totals to $4,500 before my insurance picks up all. As of now, my deductible is met, but only about $160 of my OOP is met. I've already paid my surgeons office for the surgery, so I'm guessing the bills I get from here forward will be a hospital bill, anesthesiologist bill, and I was told that I would get a separate bill from another doctor that assists my surgeon during surgery. Daronb I would never have paid surgeon. Hospital bills usually get their first.
October 16, 201411 yr I'd recommend asking, rather than getting surprised. I got lucky and only 10% (somewhere around 1500) of the estimated out of pocket was due before surgery. The remainder was billed a couple of weeks after. Since many insurance companies consider this an elective procedure, many times it isn't affected by the annual out-of-pocket limits. Of course my insurance is one of those, so I ended up paying more out-of-pocket AFTER their coverage than most people I've spoken with who have been completely self pay.
October 16, 201411 yr I'd recommend asking, rather than getting surprised. I got lucky and only 10% (somewhere around 1500) of the estimated out of pocket was due before surgery. The remainder was billed a couple of weeks after. Since many insurance companies consider this an elective procedure, many times it isn't affected by the annual out-of-pocket limits. Of course my insurance is one of those, so I ended up paying more out-of-pocket AFTER their coverage than most people I've spoken with who have been completely self pay. You need to call your insurance asap. Because that's the biggest loaded of crap I've ever heard. I've worked in insurance 20 years the oop is the oop and unless your benefit has many levels of deductible or oop, elective vs non is irrelevant.
October 16, 201411 yr You need to call your insurance asap. Because that's the biggest loaded of crap I've ever heard. I've worked in insurance 20 years the oop is the oop and unless your benefit has many levels of deductible or oop, elective vs non is irrelevant. I tried that and it didn't help. I even consulted my lawyer about it and they told me I had no case. In the end, it cost me less than a new car and I couldn't be happier with my new life, so I've moved on. I just wish I'd have known sooner so I could have done self-pay and saved some money.
October 16, 201411 yr File a copy of your benefit description and copy of bills with the state insurance commissioner You can look up your state insurance department of it doesn't have one banking department Load of crap
October 16, 201411 yr Oh believe me I have called multiple times and I am told no more out of pocket. But I also own a company that does medical services and we bill insurances. You would be surprised at some of the crap they pull. One scenario that comes to mind ...me " so what's the coverage on such and such service". Insurance " 100% of approved charges". Me" ok how much is the approved charge". Ins " oh we can't tell you that until you file a claim". Me "why not I'm the provider". Ins"sir we do not give that information out until you file a claim". Me. "Sorry mr so and so I can't sell you a much needed medical device until we get the approved amount from the insurance".
October 16, 201411 yr I paid the day off surgery and got a 25% discount. I could have set up payment arrangements and forgone the discount.
October 16, 201411 yr Or another just as good. Me" how much does the plan cover for such and such ". Ins "x amount up to xx amount". Me. " great". Patient is helped. Insurance payout comes 90 days later at only 1/10 of quotes it won't even pay for device. Oh and no balance billing. I call the insurance up. Me" so why did I only get paid 1/x. " ins" you needed to buy the product from our approve third party supplier instead of directly from the manufacture" They are sneaky is all I'm saying. They will tell you one thing but not everything you need to know. And if you don't know the exact questions then it's useless.
October 16, 201411 yr Micmt You have access to a provider rep ask to speak to them or have your issues referred. Customer service reps can't provide you this info. The proviser rep will give you a fee schedule if you ask further many insurance companies have portals. And the larger ones like aetna Cigna bcbs provide you access to their fee on that If the carrier has third party vendors I suggest you use that specific terminology with customer service folks to determine if you have to use a vendor. Be clear
October 16, 201411 yr I'm just saying what I have discover in the past 5 years. We now have a very competent patient care coordinator that we let deal. The reason y I brought all this up is that insurance companies can be tricky.
October 20, 201411 yr According to my doctor's office, I don't owe anything until AFTER surgery (thank goodness). Even though I am maxed out for the year with my insurance (out of pocket max) ,they still require 10% of the cost of the surgery as a co-pay. It's only 10% of what my doctor ends up getting paid....so if they bill 30K but only get paid 15k, then I only owe 10% on the 15k
Ok, so my surgeon's office and my insurance company haven't mentioned anything about when my deductible is due. Do most people have to pay before surgery or get billed later?