Did you have to pay anything with insurance?

[Chantrella 125]

I am having bypass surgery March 3rd through insurance approval and when my coordinator called to schedule my consents. She said I didn’t have to pay a deposit to my surgeon because my deductible was met. When the scheduler called to schedule my appointment and pre op paperwork appoint for 2 days before surgery she did not mention I would have to pay anything. I just don’t want to get to the hospital and they want 4,000.

[bufbills 314]

If your deductible is already met, and your maximum out of pocket is as well, you should be good to go. Just call your insurance company.

[Chantrella 125]

12 minutes ago, bufbills said:

If your deductible is already met, and your maximum out of pocket is as well, you should be good to go. Just call your insurance company.

I called them that’s why I’m so confused one person said this and another person said something totally different. My out of pocket isn’t reached yet unfortunately it’s a new year. Would’ve been nice if I could’ve had the surgery last year lol.

[GradyCat 3,692]

My deductible was met, but I still had an out-of-pocket maximum to meet, which was $1200.

[Chantrella 125]

22 minutes ago, GradyCat said:

My deductible was met, but I still had an out-of-pocket maximum to meet, which was $1200.

When did they let you know how much you had to pay?Was it before you went to the hospital or the day you went to the hospital? My pre op appointment is March 1st my surgery is March 3rd. I still have claims processing on my insurance so I’m not sure what my out of pocket will be because the claims haven’t been fully processed yet.

[GradyCat 3,692]

2 hours ago, Chantrella said:

When did they let you know how much you had to pay?Was it before you went to the hospital or the day you went to the hospital? My pre op appointment is March 1st my surgery is March 3rd. I still have claims processing on my insurance so I’m not sure what my out of pocket will be because the claims haven’t been fully processed yet.

I knew BEFORE the surgery, by the pre-op date. I had to pay 25% up front on the day of surgery before they'd let me have the surgery (to the hospital, not the surgeon). You could call your insurance company to see if they can give you your Out-of-Pocket remaining balance estimate based on pending claims.

[catwoman7 10,876]

I think by the time I had my surgery (in the summer), I may have been up to my out-of-pocket limit because of the classes, appointments, and all the tests I had to take before I was approved (sleep study, nuclear stress test, EKG, labs, etc)

[Uomograsso 364]

The total you should have to pay is you deductible plus your out of pocket maximum i.e.

$600 deductible + $1200 oop max = $1800

If you have met your deductible, you only need to pay up to your oop maximum, but usually after you have met your deductible, you pay a percentage such as 10% or 20% of any bill until you meet your oop max, i.e.

$12,000 hosp bill × 10% = $1200 which meets your oop max. Any bill after this would be paid 100% by insurance as long as providers are in network.

[JMJames92 113]

The billing in the whole situation confused me so much. Everything up to the surgery was simple, I just paid my $15-$30 copay for every doctor's visit. For the surgery, I was told in advance that my portion would be ~$200 and I had to pay it on the day of the surgery. At the time I was 23 years old and I did not have much money at all so I made sure to save money so I would have that $200 for my surgery. When I got to the hospital the day of my surgery they gave me a bill and I owed them just under $700. I just paid the $200 that day and explained to them that I was told $200 and I would be able to make payments. They didn't have an issue with that (thankfully).

[Chantrella 125]

On 2/6/2021 at 1:19 PM, Uomograsso said:

The total you should have to pay is you deductible plus your out of pocket maximum i.e.

$600 deductible + $1200 oop max = $1800

If you have met your deductible, you only need to pay up to your oop maximum, but usually after you have met your deductible, you pay a percentage such as 10% or 20% of any bill until you meet your oop max, i.e.

$12,000 hosp bill × 10% = $1200 which meets your oop max. Any bill after this would be paid 100% by insurance as long as providers are in network.

Yes I have met my deductible, but not my oop max just yet. I think I understand you. I am still in my coinsurance phase so I would be paying 10% of my surgery total?

[catwoman7 10,876]

1 hour ago, Chantrella said:

Yes I have met my deductible, but not my oop max just yet. I think I understand you. I am still in my coinsurance phase so I would be paying 10% of my surgery total?

I know you didn't ask me this, but yes, that's how it works with most insurance companies - although yours may be different. You could always call them and ask - then you'd know for sure.

[Chantrella 125]

34 minutes ago, catwoman7 said:

I know you didn't ask me this, but yes, that's how it works with most insurance companies - although yours may be different. You could always call them and ask - then you'd know for sure.

Yup, I called them I pay 10% until I reach my oop max. Thank you that really helps me figure out how much I will be paying on the 1st.

[Chantrella 125]

Update for everyone my coordinator called me today to ask if I knew how much I had to pay for surgery at my pre-op. I told her yes 10% of the procedure since so am in coinsurance phase. She told me that didn’t sound right and to call the hospital they would know for sure. So the hospital said I have the best insurance because all I pay is 300.00 everything else is covered. A little lost I called my insurance asked to speak to someone high up and they too confirmed only 300.00. Like wow! I haven’t even met my out of pocket yet. So thankful I decided to get the more expensive policy for 20 extra bucks a month.