Tyger Posted February 2, 2009 Report Share Posted February 2, 2009 OK, so my DD needs her adnoids & tonsils removed. Got that. Now, I'm trying to find out, thru the insurance, and the doctor, how much, what, where, and all that jazz. First the doctor said it was an outpatient proceedure, done right in the office. Ok, how much will that be in total, since we haven't met our deductable yet? I think around $500, but let us get back to you.....3 mos later, still no info. With everything going on, we weren't planning on doing this until this month anyway, an to be honest, it's slipped my mind. So, now we have some money saved up, and really close to what we were quoted, and I call, to get some more information, and hoping that the doctor's office actually did their homework, as they said they would. Apparently not, cuz they haven't had any sort of info in DD's file. Hmmmm, ok. Well, the nurse that does all this is out to lunch (of COURSE she is), and could I call back......Yeah. OK, I consider myself fairly intelligent. I can learn lots of things, I ask questions. Seems like nobody can answer them though. Jeez!! All I want to know is how much I have to bring with me, do I have to pay for the entire surgery (we have a $1000 deductable), or will the insurance cover some of it, even though our deductable hasn't been met, or what???? I don't want to get there and find out we have a butt load of money we have to come up with.I JUST WANNA KNOW WHAT TO DO!!!! Quote Link to comment Share on other sites More sharing options...
Members pappyld04 Posted February 2, 2009 Members Report Share Posted February 2, 2009 That sounds like a piss poor insurance policy for a roughneck. I'd suggest looking into a better policy on the outside if he is getting this through the company! Quote Link to comment Share on other sites More sharing options...
Members WendyNY Posted February 2, 2009 Members Report Share Posted February 2, 2009 OK, so my DD needs her adnoids & tonsils removed. Got that. Now, I'm trying to find out, thru the insurance, and the doctor, how much, what, where, and all that jazz. First the doctor said it was an outpatient proceedure, done right in the office. Ok, how much will that be in total, since we haven't met our deductable yet? I think around $500, but let us get back to you.....3 mos later, still no info. With everything going on, we weren't planning on doing this until this month anyway, an to be honest, it's slipped my mind. So, now we have some money saved up, and really close to what we were quoted, and I call, to get some more information, and hoping that the doctor's office actually did their homework, as they said they would. Apparently not, cuz they haven't had any sort of info in DD's file. Hmmmm, ok. Well, the nurse that does all this is out to lunch (of COURSE she is), and could I call back......Yeah. OK, I consider myself fairly intelligent. I can learn lots of things, I ask questions. Seems like nobody can answer them though. Jeez!! All I want to know is how much I have to bring with me, do I have to pay for the entire surgery (we have a $1000 deductable), or will the insurance cover some of it, even though our deductable hasn't been met, or what???? I don't want to get there and find out we have a butt load of money we have to come up with.I JUST WANNA KNOW WHAT TO DO!!!! Quote Link to comment Share on other sites More sharing options...
Members mailahn97 Posted February 2, 2009 Members Report Share Posted February 2, 2009 Tyger my background is actually medical billing. How they should work it is the following. They meaning the drs office doesn't know how much your deductible is or if it has been met that is not shared with them. What will happen is after the procedure their medical biller will submit the charges to the insurance company. You insurance company then pays their part and also lets the drs office know how much your part is. They should not bill you then as they do not have that information. The only thing they may charge you that day depending on the plan is your normal doctor copay. I hope that helps. Quote Link to comment Share on other sites More sharing options...
Members WendyNY Posted February 2, 2009 Members Report Share Posted February 2, 2009 Whoops---sorry for copying all that again !! I'm still learning how to send replies.Anyway, Tyger, I have worked for medical insurance claims companies in the past for a long time.Insurance companies are VERY hard to deal with. (along with Dr.s offices !! ) What I would suggest (if you haven't done this yet) is to contact your insurance company. I know it's very hard to get a LIVE person to actually speak to these days. Explain the problem to them. In the past, where I worked, the doctor's office could send the insurancecompany a letter stating what procedures they would be doing and approximately what they would be charging.They will need to include the CPT codes on there for each procedure. They will tell you that it's NOT AGUARANTEE as sometimes during the surgery they will have to do something else for whatever reason. You should not have to pay anymore than necessary upfront because when all is said and done, you don't knowexactly how much the insurance will cover. Also, please know that there will be other charges (usually) outsideanesthesia companies, labs, xrays if needed etc. etc....... there are always more bills involved. Good luck !!! Quote Link to comment Share on other sites More sharing options...
Members mailahn97 Posted February 2, 2009 Members Report Share Posted February 2, 2009 The other thing to remember what the doctor actually charges and what the insurance companies contractual agreed rate is different. For instance if a procedure is $2000 but due to contracts with the provider the contract states $1500 for that procedure then the doctors office is not allowed to charge over that for the procedure and try to collect it from you. Then what would happen is your amount left of your deductable will be subtracted from it. The insurance company then pays the difference between the $1500 and whatever your out of pocket will be.This is something that truly the drs office and the agent at your insurance company will not be able to answer for you. The agent at the insurance company can look up your insurance and tell you how much you have paid towards your deductable and confirm if need be how much your deductable is. That is something that once it gets to the claims department of your insurance company will be done. This has alot of factors such as doctor, average cost in area of procedure and average income for the area as well. Ther eare a lot of factors. Best I would say is call ask what the balance is for your decutable for this year. Other than that if your insurance company is 100% then that will answer at the most how much you will need to pay. If you have any questions you can send me a message. I have been doing this for over 10 years and have no problem helping you in any way. Quote Link to comment Share on other sites More sharing options...
Members mystofpric Posted February 2, 2009 Members Report Share Posted February 2, 2009 Wow, i would think that they would help pay for some of it even if your deductable isn't met, but then again I have a PPO and I only have co-pays. That being said. I'm all for pestering people until they give me the info i need, especially when it comes to money or medical things! Call back at an hour earlier tomorrow or an hour later than you called today to make sur eyou catch that nurse. Then tell her that you need the information ASAP and also, just to be on teh safe side, find out what their feelings are on payment plans, if it is 1000 and you have to pay all of that (your deductable), but only have 500 often times they will work wih you for the rest. Quote Link to comment Share on other sites More sharing options...
Members ohshelly Posted February 2, 2009 Members Report Share Posted February 2, 2009 It can be frustrating when you can't get a straight answer to a simple question. Quote Link to comment Share on other sites More sharing options...
Members ManofHerdreams Posted February 3, 2009 Members Report Share Posted February 3, 2009 Wow, we must be lucky because when I had to have surgery on my ear a couple of years ago and also when my wife had to have her gall bladder taken out last summer we were both told up front exactly how much our part of the procedures would cost us. We both had a very few small additional cost come up after the surgery but it wasn't much.I think I'd be camping in someone's office until I got some answers.Man Quote Link to comment Share on other sites More sharing options...
Members ohshelly Posted February 4, 2009 Members Report Share Posted February 4, 2009 Did they ever get back to you with the right info? Quote Link to comment Share on other sites More sharing options...
Tyger Posted February 5, 2009 Author Report Share Posted February 5, 2009 I have decided that I am going to call them and TELL them what I am going to do. Apparently, if I bill the SURGERY to the insurance, it'll cost almost $300 more than if I paid cash price. So I will pay for the surgery, upfront, cash price, and pay my Outpatient deductable with our insurance at the hospital ($200). They can freakin' bill me the rest, damnit. After all, I'd be getting a bill from the hospital and the anastethiaologist (NO clue how to spell "the guy that knocks your ass out") anyway, so, so long as the surgeon is paid for, that should be the major biggie right there. Quote Link to comment Share on other sites More sharing options...
Members ohshelly Posted February 5, 2009 Members Report Share Posted February 5, 2009 Sounds like the best approach since they don't want to cooperate.I think they forgot that YOU are the customer!Yeah, the guy who knocks your ass out..............I like that!! Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.