could really use any advise

Hi had my surgery 02/22/05 and really did not have trouble with approval and they paid well for hospital stay and tests ect... but when it came down to paying my surgeon they are not cooperating! He charges $12635.00 and they only sent me a check for $1100.00 said I'm responsible for $11,453.60 this is a problem since my Doc was out of network and I paid him upfront $6500.00 which I borrowed and is coming due I think it's rediculas to think that an insurance company really believes that a surgeon can perform laporoscopic gastric bypass for $1100.00 I have appealed but was curious to know if anybody else has had to deal with this and what they did to resolve it. Thanks Todd p.s below 300 now yeahhhhhhhhhhhhhh

Hi Todd, It definitely depends on your insurance carrier. I have BCBS of MA and my surgeon had an assistant during my procedure. Well the assistant sent a claim in for 5,000. My insurance company does not pay for assistant surgeons. I called them (bcbs) and appealed via phone. I told them that I did not know an assistant was going to be helping, I didnt know it was against their policy and I was knocked out under anestetshia (sp). He listened and adjusted the balance... So my advise it to continue to appeal.. Good Luck Todd and I hope it gets better Brigitte