Out of pocket payment before Insurance??

[AmandaD. 35]

Hello!
Just a question about insurance & how they normally bill since I am completely new to this & just beginning! My insurance has a $1,400 deductible & then afterwards covers 80%. Would I have to pay the other 20% upfront or do I get billed for that after surgery? I know it seems crazy to ask but I was pregnant last year and my insurance company made me the estimated percentage that they did cover up front - making me come up with $6000 in 30 days or they stated they were dropping me from my OB. I think they called it global authorization or something weird. I just didn’t want to be blindsided getting a letter a few months in having to come up with a large lump sum in a short period.

Thank you! Hope all is well on your journey's!

[liveaboard15 1,294]

Typically you need to pay that before hand when you book the procedure. But some places will do the procedure then submit to your insurance for payment and once they get their payment they would bill you for the remainder which would be due in full unless you made payment arrangements with the hospital. I would call your insurance and hospital to get a legit 100% firm answer on it. I was self pay and to book my surgery i had to pay almost everything up front.

[Toomany#s 59]

I know that I have generally had to pay the deductible up front and then be billed for the remainder, but best to check with your insurance to see how they do it.

[jenuinelygenuinely 81]

I have Blue Cross Blue shield and it requires the 6 month dietitian visits. They billed me as my appointments went on, but if you let it pile up they require you to pay the full amount before you schedule any pre-op surgery appointments. (After completing the criteria)

For example I paid $400 for my first bill, which was the 4 initial appointments. Consult, therapist, dietitian, and doctor within the endocrinology department. and then every month I was billed again but a different amount. I paid $2800 total but not up front.

If I didn't the pay the bill when I received them and let it pile up to $2800. I would have to pay that to schedule my surgery

You can definitely call the customer service phone # about your benefits of your insurance and they will be able to explain to you how it works.

[kcuster83 1,505]

I was "asked" to pay before hand but I told them I wanted to make one large payment so I could take advantage of a deal my CC was offering. The higher amount the longer the super low interest special.

They did not argue and just said ok.

By the time I got the bill, the "interest special offer" was over. HAHA! b*****s!

[liveaboard15 1,294]

2 hours ago, kcuster83 said:

I was "asked" to pay before hand but I told them I wanted to make one large payment so I could take advantage of a deal my CC was offering. The higher amount the longer the super low interest special.

They did not argue and just said ok.

By the time I got the bill, the "interest special offer" was over. HAHA! b*****s!

LMAO that sucked. Reminds me of my discover card. When i first got it it was interest free for like 18 months.

[AmandaD. 35]

@kcuster83: Did they charge you just your deductible up front before your surgery or did you have to pay the difference /percentage in procedures, etc that your insurance didn’t cover up front as well?

[kcuster83 1,505]

18 minutes ago, AmandaD. said:

@kcuster83: Did they charge you just your deductible up front before your surgery or did you have to pay the difference /percentage in procedures, etc that your insurance didn’t cover up front as well?

They wanted a portion of it, I think they asked for like $3000 up front. But I explained that I would be paying more than that because of my "max out of pocket" with my insurance and wanted to pay everything at once.

So, I didn't actually pay anything up front.

[kcuster83 1,505]

27 minutes ago, liveaboard15 said:

LMAO that sucked. Reminds me of my discover card. When i first got it it was interest free for like 18 months.

Yea, and the hospital wants $460 a month for zero interest payments. I can use my CC and get a bunch of points and just make those payments to them and pay it off faster.

[AmandaD. 35]

Yeah, that makes sense for sure. Do you mind me asking how much your total due was?? My insurance pays 80% so I’m assuming my out of pocket with deductible will probably be around 5-7,000. I appreciate the info!!

[AmandaD. 35]

Sorry, never mind the last question, I didn’t see the first answer up top lol thank you!

[Sunshine Princess 203]

DO NOT PRE PAY YOUR 20%!!!!!

Wait until the bill has gone to insurance, gone through pricing and re-pricing and then pay when you receive the bill after surgery. You want to make sure the portion you pay is the same as your Explanation of Benefits (EOB) from the insurance company.

Also, find out what your Out of Pocket Max is. If you reach your Out of Pocket Max before surgery, you wont be paying anything for surgery.

Depending on your insurance plan year, your deductible may reset at a certain point (January 1st is a popular reset date). If you're starting the process now, anything you pay this year will not be used next year, and you'll have to satisfy the deductible again.

[kcuster83 1,505]

10 minutes ago, AmandaD. said:

Yeah, that makes sense for sure. Do you mind me asking how much your total due was?? My insurance pays 80% so I’m assuming my out of pocket with deductible will probably be around 5-7,000. I appreciate the info!!

My max out of pocket is $6500. I basically had to pay just about 6500 because I had my surgery early in the year and hadn't used my insurance too much yet.

[AmandaD. 35]

On 08/02/2022 at 11:03, Sunshine Princess said:

DO NOT PRE PAY YOUR 20%!!!!!

Wait until the bill has gone to insurance, gone through pricing and re-pricing and then pay when you receive the bill after surgery. You want to make sure the portion you pay is the same as your Explanation of Benefits (EOB) from the insurance company.

Also, find out what your Out of Pocket Max is. If you reach your Out of Pocket Max before surgery, you wont be paying anything for surgery.

Depending on your insurance plan year, your deductible may reset at a certain point (January 1st is a popular reset date). If you're starting the process now, anything you pay this year will not be used next year, and you'll have to satisfy the deductible again.

How do you get away with not pre paying? From my experience (just from being pregnant) they basically threatened me stating I had no choice lol are there ways to tell insurance you would like to be billed at the end after insurance and only pay deductible first? My deductible is $1,400. My whole process isn’t starting until Jan 1st because I’m switching to my job’s insurance during open enrollment this year. My out of pocket max is $3,000. So I would (more than likely) pay my out of pocket max AND my deductible ($4,400) before surgery and if they try to have me pay the 20% as well tell them I would like to wait? This is all confusing so I just want to get as much info as possible. Thank you!!

[Sunshine Princess 203]

You don't tell the insurance company; you tell the provider. Tell the provider that you will pay the final amount after insurance has processed the claim. You also don't pay the deductible upfront; the deductible is accumulated through medical expenses like prescriptions, doctor's visits, etc. You pay the negotiated rate to the provider AFTER the insurance company has processed the claim.

I counsel my clients to never pay until insurance has processed the claim because getting a refund from a medical provider is like waiting for hell to freeze over.