FREAKING OUT!!!!

After I received my insurance approval for this surgery I was told that my insurance company (Medical Mutual Ohio-super plus) would cover everything. Well, I just received a bill from St. Vincent Charity Hospital stating that my total bill was a little over $32,000.00 and my insurance only covered a little over $24,000.00 which leaves me with a little over $8,000.00 I have to pay out of my own pocket! We don't have this kind of money!!! Which is why I sought insurance approval. There was no way I could afford this surgery... and if I knew I had to pay out of pocket I never would have had it done. What the heck am I going to do now? I don't want to be in debt for over $8 grand! I am seeing RED right now!

well first of all they should have stated how much they will pay before u had surgery before U had surgery I had to pay my portion when I registred for surgery.. u should take the bill down and say hey what is with this? how come u didn't inform me.. and call the insurence company and say nothing was mentioned i would have to pay 8 k out of pocket.. fight it second if by some mistake u owe this amount u can audit the bill and make sure u were not over charged?????? wow 32 k sounds a bit high for a RNY.. my hubby was only 24k my band was 18 k good luck Lisa

I keep getting bills that weren't included in the surgery that I wasn't really told about. I paid my surgeon $3500 - I thought that covered everything. I guess not - I got another 1000 bill for the anastesia (ap?) and then another $2000 deductable bill for the hospital stay. I am really frustrated because no one told me about the hospital deductible - the surgeon on breifly mentioned that the anastesiologist (i butchered that) MIGHT charge me if he didn't accept aetna. What kind of anastesiologist doesn't accept aetna? Sorry for the rant, but I totally understand. I don't have any extra money for this. I am SO graetful to have had the surgery but I think I might be paying it off for the next 10 years....

I know the feeling. I have lots of bills from the pre-op testing and stuff too. But that is how your insurance probably works. Mine has a $500 deductible (I have to pay the first $500 dollars every year), then it pays 80% of everything else (some things it covers completely, I don't understand all of that) but my out of pocket is $2000 a year. So I owe about $1500 from last year and the full $2000 from this. but still have to pay like my $20 copays to docs for visits and stuff. I send in 5 dollars a month to all docs and hospitals, I was always told if you do at least that they can't come after you. I'm trying to get some financial assistance at least for the surgery. plus I owe $40k+ for student loans, and over $10k in credit cards. never gonna be out of debt at this rate. I have considered bankruptcy, but you can't bankrupt student loans so it really wouldn't help me too awful much. My bills, rent and living expense are more than I make every month, so I do lots of juggling.

I've gotten a few bills that appeared to require me to pay something, but I had checked and there was no co-pay from the insurance, they explained that sometimes bills overlap and it looks like you owe, but you don't. Have you called your insurance to check? My surgeon sent me a bill for about 16,000, but it was because they were billing everything that hadn't gotten caught up to by BCBS. It too****il late May for it to all settle down, now I'm just appealing one bill, because they said my surgeon isn't a network provider (and he is) and they denied it, when they have paid all the rest of his bills. It's good to know I"m doing their bookkeeping for them! I know that with BCBS, they only pay a portion, but part of the provider's agreement is to accept what BCBS pays and then cannot bill the patient the rest. I hope it works out, because that's a really unpleasant surprise!! I"d be seeing red too!! Inky

My surgeon's bill alone was $45,000 !!! When he got inside me it was more complicated than a regular RNY, he had to do a gastrectomy and liver biopsy and charged additionally for them. My insurance has paid $21,000 and that's with an appeal. I don't know how I am going to to pay the other $24,000. And then there's all the other fees. My hospital fee was tremendous , but paid for. It is definitely a great hardship and a source of stress

Lisa, I would appeal that amount because they are supposed to let you know upfront any copays you might have. You should not be charged for their negligience. I work for a hospital and I am the finance manager over all business services. I know what I am talking about. Good Luck Roz

My suggestion is to go to the person that manages your benefits plan (whether its your HR or your husbands) and ask them what they can do to help. Most likely, it will be nothing, but then you ask them to give you the name and number of the insurance broker (the person who sells the insurance to the company). The insurance brokers work closely with the insurance companies because their businesses are mutually beneficial. The I.C. wants the broker to send them business and the broker wants the insured folks to be happy so the employer doesn't pull the account and get another broker. Don't bother fighting this on your own. I spent 6 weeks trying to get answers from my insurance compnay and they gave me the run around. Once I got the broker working on it for me, I had an answer in 48 hours. Unfortunately, it is always about money and you have to go to the source. You should also be prepared though. Insurance policies are notoriously complicated and unless your (or your husbands) HR was explicit with you about the details of the plan, something may have been overlooked and you may be on the hook for the cash. I am sorry, but it does happen. I have made that mistake a few times. If that is the case, talk to the billing department at the hospital, they may offer low interest financing or may have a institution that can offer a low interest loan. I am sorry you have to go through this while you are healing.

Since you don't mention the type of benefit plan you have, this may be way off. Most hospital procedures require precertification from your insurance company. Once the insurance company approves the procedure, you should have received a letter telling you that you were approved and the hospital has been notified of same. This letter should have also summarized your out of pocket requirements. If the hospital accepted your insurance and you as the insured have met all your deducibles and copayments/co-insurance, the hospital can not balance-bill you for charges that the insurance company doesn't pay. Your insurance company should have a provider agreement with the hospital that specifically outlines what they will pay for procedures, room/board, etc. For example, my physician billed my insurance company $15k for his surgeon fees. Aetna only paid about $3k. My co-insurance responsibility was $1.2k. The remainder of his fees should be written off. Pull out your insurance certificate of coverage or plan document and read it. This should spell out for you what your obligations are as well as what your out of pocket maximums are. If you are still at a loss, call your member services department and get your HR person involved if necessary. Good luck!