Question, BCBSNC?

Hey Ya'll Can someone who is postop and in the process of getting bills/EOB's  help me with a question?  I'm trying to do a little financial planning.  My wife scheduled her surgery last week and, due to her having NO COINSURANCE (can you belive it?!) and having met her deductible with the preop testing, she had to pay $0 out of pocket after she scheduled.   I however, have 20% coinsurance which will have to be paid before I can schedule.  I'm curious to know if anyone can tell me what the "allowable amount" for the surgeon is with BCBSNC.  That way I can be prepared to pay that day.  The paperwork at the surgeon's office says that the surgeon's fee is $6500, but I'm sure that the contracted amount is less, and I should only be asked to pay my portion of the allowed amount...I guess.   Anyway, any info ya'll can provide would be great!

Not in the process as I am still pre-op but have worked with insurance billing/doctors offices so..... Yes your figuring seems correct - the allowable the doctor gets is lower than what they bill.  Have you called and asked them (the doctors office) what the allowable amount is and how much you would owe with your 20%  ?   I would think they could tell you....I know we can tell our patients what the ESTIMATED amount they owe is.  (Remember that word estimated - sometimes the figures after insurance is billed are way off from what was expected due to numerous factors).

Sorry i cannot be of further help with specifics. Good luck to both you and your wife. Mary

The allowable amount for the surgeon is based on that surgeons particular contract with BCBS nc... I can tell you that my 20% for my surgeon was around 260$. The surgeons office should be able to tell you how much it should be since they know their contracted rate.

I have State Employees Health Plan--BCBSNC.  I had my surgery in July when my new insurance year started.  I have the same doctor's office as you.  Since I had not met my deductible for the year I ended up havng to pay around $1200 to the surgeon.  There is a big chunk that you don't have to pay because they are "in network providers".    If you have gallbladder surgery at the same time may sure that it is also preapproved before you have your surgery.  This can create problems with payment afterwords.     Call Tanya at the doctor's office and ask any insurance questions.  She is very helpful. 

I have BCBSNC  out of  pocket to my surgeon is $1949.00 and the Hospital is $1866.50 both have to be paid before my surgery date.  I don't think that's to bad at all.

Bobbie had told me to be prepared for about $3000-$3500 for everything out of pocket, and that's about where I'm at... My office co-pays were/are $50.  I think my part for doctor was about $1200 and then what I paid to Pitt and the other co-pays for psyc  eval and such. I have BCBSNC but a one person group policy for my bizz.  I opted for higher co-pays to keep my monthly premiums lower (but would have changed that last year had I known I'd be doing this). 

Thanks everyone!

Hi!  I just received the EOB for my surgeon and BCBS of NC paid him $4050 of the $6000 he billed for.  I paid 10% upfront, but the insurance lady at the office told me to pay $600.  Anyway, since I was only supposed to pay $405, I have a refund of $195 coming!!  I had to pay $100 to the hospital, $15 to the psych (co-pay only), and $200 to the nut.  I also got billed for about $87 in co-pays for the anesthesialogist after the insurance paid the rest of the bill.  Overall, not too bad.  I have BCBS of NC federal employee program as my insurance carrier, by the way.  Good Luck to you and your wife!!

BCBSNC has a out of pocket limit. I don't know what plan you have but my out of pocket limit was $2000.00 with a $1000.00 deductible. Initially I had to pay my surgeon upfront the deductible plus the 20% co-pay, which was $1295. My total bill from the hospital was around $28,000(Lap RNY, two nights stay, no complications). BCBS paid 100% of my surgeon fees and all but $2000.00 of my hospital stay. My surgeons office sent me a refund check for the $1295.00. So look at your plan to see what your out of pocket limit is. Hopefully that will be the amount you owe. Good Luck Peace, Karla