Insurance Coverage

I am so mad right now.  I have state employee Schaller Anderson EPO.  My first surgery date was set for October 3, 2007.  SHC made a mistake and I ended up getting denied a few days before surgery.  However, when they checked benefits they said I had ZERO out of pocket costs and that my insurance is the best for coverage.  My benefits have not changed since my first surgery date!  I even signed a paper saying that I understand what I owe and that being ZERO. I got approved and got my new surgery date. They just called me and TWELVE hours before my pre op appointment and tell me they need to take a deposit of $1100.00 TOMORROW for the 10% that I owe!  WHAT!  Then they tell me I will actually owe a total of about $3000.  I am so mad that I am just now being told that.  I am just in shock.  I told them giving me 24 hours notice that they want $1100 is totally unexceptable.  Giving me 30 days notice that I have to come up with a total of $3000 is even more shocking.  They have been telling me this entire time that I have NO out of pocket costs.  I called my insurance and they confirmed exactly what I thought.  They said the only expense I may have is 10% of my room and board and thats ONLY if they bill for a private room (which SHC still bills semi private)   So I tried to tell the hospital this and they tell me that its wrong and I owe them this money.  UGH!  I am so stressed out about this, I just want an answer....a correct one. 

I don't blame you!!  I get so tired of insurance companies playing BS games.  After I broke my leg in November, my company held off on submitting my end of coverage for a while.  I filed cobra ASAP, and it's taken them over 2 months to it back in force.  Insurance companies suck, with hospital billing departments right behind them!

Talk to the hospital again.  I too am a state employee and I got this same call a few days before my preop class letting me know they got approval from insurance for the hospital stay.  At that time she also said it looked like I would have 10% coinsurance.  I told her (it was Lisa I think), that under my plan I do not have any coninsurance except for possibly the cost of the room only but my understanding was that the hospital writes that portion off.  She said she would make a notation.  I then called and confirmed the same information with the insurance company (that the most I would owe was the 10% for the private room).  I know from my conversations, no other state employees on this board w/ the policy have had to pay the 10%.  When I showed up for preop class they had a list at the end of the day of people who had to pay their portions up front.  I was not on that list and was not showing as owing anything.  Keep in mind the hospital and Scottsdale Bariatric bill separately for each of their services.  My understanding is you shouldn't have to pay anything.  I have not paid anything and have received no request for payment.  At no time was I told a specific dollar amount I may have to pay and they asked me for no money when they were collecting from everybody else.  I would speak with the hospital again but you shouldn't have to pay anything and definitely not $3000 (there is no way that is 10% of the cost of the room only).  Take a deep breath, it should all be okay!  (At least I hope it is or I could be in trouble too.)  Now if this is Blackstone's office asking for the money, something is seriously, seriously wrong and they have the wrong info in your file. Rebecca

Hey Lyns,  Sorry this is happening to you at this time.  I would call the insurance co and get somebody's name and have THEM call the hospital.  It is THEIR responsibilty, not yours, to take care of this. Breathe, breathe..

Oy' vey thanks guys!  My patients with Scottsdale is very thin.  I loooove the doctor and post op team and program but have been through hell and back with pre op and everything involved before surgery.  So, this was the straw that broke the camel's back I guess. I called back Lisas supervisor Andrea and told her what my insurance said and what I know for fact other patients with my policy have paid.  She still did not believe me.  She said she would call me back.  She hasn't yet.  I have tried calling several times but I guess in my pre op class tomorrow I will have to get this straitened out.  Thanks again!  This is why I love this site and all of you! Lyns

I was really worried about this for my preop class but when the lady came around with the money collecting list, I was not on it. I asked her and she said if I wasn't on there at that point she would be surprised if I owed, just keep calm until tomorrow and if they are insistent I would tell them you need time to work out a way to come up with the money and then call the insurance. If they are really trying to charge you that much, which is clearly more than 10% of the room cost, something is off and insurance should call them on it. Wait and see what happens, hopefully it will turn out like mine.

I am a State employee too - with UHC, but all the State's EPO policies are the same. There is no charge you will have to pay for the hospital stay.

Actually Lisa told me I had to pay 10% for the total surgery!  Thats where the $3000+ comes in. I really think they are wrong (the hospital). Now after talking with you, I am sure of it. I am confused by the UHC EPO comment....so did you have to pay a portion of the hospital room or no? 

Well, you should be out of class soon.  I hope it went well (and OMG did you guys have the broccoli salad thing, YUMMY!!) and I hope they ended up telling you that you owe nothing. Rebecca