Insurance question...please help!

rabid24 · May 16, 2007

Hi!

I know that my insurance will pay 90% of my surgery costs, and although I know it's probably different from place to place I was just wondering what I should expect. Will they ask for the other 10% up front, or will they bill me for it and allow me to make payments?

I would love to hear any and all stories in this department.

TIA!

Jodi

Band Chick · May 16, 2007

The Drs I have looked into so far all want any portion not covered by insurance paid before surgery.

What insurance do you have and what state do you live in? (looking for a new ins. company)

rabid24 · May 16, 2007

I have Federal Blue Cross Blue Shield.

It's funny, I have the Standard Option (which is the most expensive), but if I would've taken the basic option I would only have to pay $100 for this surgery instead of $1300, and I would've saved $80 a month in insurance payments. Guess I'll be changing in open season!

GayleTX · May 16, 2007

I had to write a check for half of the amount I owed when I checked into the hospital. The rest I paid out after the surgery. I'm sure it depends on your doc's/hospital's policy.

musicalmomma · May 16, 2007

I have a $300 deductible (which I reached LONG ago) then 10% after up to a maximum of $1500 for the year. I'm getting billed after the insurance pays their portion. I guess Wisconsin folks are more trusting, cuz in Delaware (where I'm from) I would have had to pay my portion up front.

My insurance stinks though, because they have YET to pay ONE bill properly!! I've had to call on every single bill to get them to submit it correctly! It's been a nightmare cuz both hubby and I are doing LapBand!

violeteyes37 · May 16, 2007

My insurance is UHC choice Plus and I was also covered at 90 10. What I had to pay was the maxium out of pocket deductible for the year, which was 1000 and needed to be paid at the time of my preop.

Alexandra · May 16, 2007

Hi!
I know that my insurance will pay 90% of my surgery costs, and although I know it's probably different from place to place I was just wondering what I should expect. Will they ask for the other 10% up front, or will they bill me for it and allow me to make payments?

I would love to hear any and all stories in this department.

TIA!

Jodi

Hi Jodi,

The answer to this depends on the specifics of your plan and the laws in your state. Are you paying 10% of the in-network negotiated rates? That would mean you would pay AFTER the insurance carrier has received and processed the claim; only then can the providers know what portion is appropriately yours.

Or are you paying 10% because all the providers are out of network and that's your coinsurance? In that case, there are no negotiated rates to think about (more's the pity) and you will be paying 10% of the retail price. The providers would have every right to ask for that money up front.

Call your insurer and ask. The good news is that no matter what the answer, the vast majority of legitimate medical providers will be happy to work out a payment plan if you are unable to come up with all the money you owe at one time.

violeteyes37 · May 16, 2007

Actually what I paid was just the maxium out of pocket. Not deductible. The 90 10 is the coinsurance and this portion of what you are expected to pay should have a maxium. If not you could end up paying a lot in that 10%.

Alexandra · May 16, 2007

Actually what I paid was just the maxium out of pocket. Not deductible. The 90 10 is the coinsurance and this portion of what you are expected to pay should have a maxium. If not you could end up paying a lot in that 10%.

Yep, that's what I meant about the state laws coming into play as well. Many states have a maximum-out-of-pocket (MOOP) limit that plans have to adhere to. So look at your policy to see what the MOOP is on your plan. Your 10% might hit that number and that would be your ceiling.

juliegeraci · May 16, 2007

You can probably negotiate that with your doctor. My doctor had me pay roughly $2k up front to cover the anastesia and some fills.

rabid24 · May 16, 2007

I knew this would be more complicated than it sounded in the little insurance book.

The surgeon is a preferred provider, and they have pre-set rates that they can bill at. I would be billed the 10% of that up to a maximum of $4500 a year. I have a $500 deductible to meet, but the 10% would be a lot more than that.

Thank you all for your help!!! This has been enlightening. I've been trying to call the surgeons office with this question for 3 solid days, but apparently they are very popular. I just wanted to know if I should be trying to get the rest of the money together up front. I thought they would probably take the insurance money and bill for the rest. Of course, they are so busy they wouldn't really need to work out a deal with anyone.

Thanks again!

Jodi