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out of network after the fact



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:cry

I had surgery with Dr. Spiegel July 28th, at the surgicenter

Received my explanation of benefits only to find out the surgicenter is out of network. No, I did not check on this before hand, but now am really stressing over the money it may cost. Called the surgicenter the referred me to their main office, she was not able to tell me how much it is going to cost me out of pocket, because they have not received the payment from UHC yet. HAS ANYONE EXPERIENCED THIS? AS, I said I KNOW I should have asked about this before hand, but it also seems like someone could have told me this at the surgicenter!?!?!?!?

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Every policy is different, but I have a max out of pocket of $1500. I used an out of network surgeon but the hospital did the billing for him (as a package) and it was covered 100% but if he had billed seperatly I would have had to pay $1,500 total. I know because I called and ask the insurance company. There should ve something on the EOB that states provider may bill you $xxx is that not on there? Mandy

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Sue,

How ironic! I am going through the exact same thing! I was banded on 8/9/05 and I just found out that the surgical center that I used was out-of-network. I assumed that since my surgeon was in network the surgical center was also. Man am I stressing! Assuming that UHC will pay 70%, thats still leaves me with 30%. Like I told my wife, what are they going to do? They can't have it if we don't have it! They'll have to accept some payments that we can afford and that is the bottom line. Well thanks for listening to me vent. Let me know what happens. Regardless. the surgery center and my surgeon are awesome. Good luck.

Ray

8/9/05

Dr. Snow

Fort Worth

280/259/180

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Reposses the band! LOL!!!! That is hilarious!

Can they do that?

Ray

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I don't know if this helps, but my surgery center was out of network. When I asked about the insurance payment on it, they told me they would accept the in-network allowance, and not penalize me for it. Maybe this is the same for you. Good luck! Cindy

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That is what I was told as well Mouse. The Surgery Center of Richardson is an out of network hospital for UH, but Dr. Benavides is an in network doctor. But the sugery center in only going to charge me the in network price.

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You're right, whoever got your approval should have educated you on the fact that the facility they use was out of network. My insurance said to me, if there were other facilities in the area that were 'in' network, they would not even pay out of network benefits. Hope this is not the case with you..

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hopefully you have out of network benefits. I also have UHC but have o out of network coverage. I am having a problem with the radiolgy department being out of network when I made sure I went to an in network facility!! Now they want me to pay 3000.00 for their services on my surg and my sons appendectomy 2 weeks prior to my banding!!

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I was going to use The Surgery Center of Richardson, they told me they would accept what insurance paid and only bill me the 20% as was my in network rate. But they could not tell me if the 20% was of billed charges or of the reasonal and customary charges... There's a big difference in 20% of $27,000 and 20% of $7612.08. (actual allowed charges for surg.) I found another Dr who would do surg at an in network facility.

Loving my band and losing.

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I was banded by Dr. Spiegel on July 20. I also have UHC. If I am remembering correctly, the dr. office knew that the surgicenter was out of network and I would have to have it at the hospital. I knew this myself already because my husband was banded a year ago. I hope everything works out for you.

Good Luck!

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I used Dr. Powell who is in network for me. The Surgery Center of Richardson whould have ben out of network, so I ended up having mine at Renassiance (sp) Hospital instead.

I asked my insurance company before surgery if I used SCOR if there would be a problem and they said yes that they were out of network and I would have to pay the difference.

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Yes it is Sue,

Ray

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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