Insurance question for EVERYONE

If im not prying..... What insurance carrier did you use for surgery? How much out of pocket have you paid? I have BCBS thru my job. I have a 1000.00 deductible.  I rec'd a call from Southern Surgical about my endoscopy. it is scheduled for 6/4 but i have to pay 388.11 to them ( the procedure is 875.00) i know absolutely NOTHING about how this works, especially with the deductible.  Can someone please try to explain this to me. I asked her if i would have to pay amounts like this when i see the other specialists. she said no just the copay. FYI- we rec'd our stimulus rebate today also . I really think God is looking out for me and making this happen. Praise Him  thanks so much

OT:  You've already got a call!!!!!!!  I am sooooooo greeeeeennn right now!  (Happy for you though) Oh, I am so happy for you that you got your stimulus check!!!!!  What a blessing!!!!!!!! I can;t help you alot on the insurance.  Hopefully someone can educate both of us.  When I had my back surgery I only had to pay my co-pay for office visits.  My steroid injections (*which by the way didn't help me) were covered also and I just had to pay for an office visit.  After the surgery, I had to pay my deductible plus 10% of the hospital bill.   Sorry I can't be of more help.

HEY DONNA!! dont be too quick to get all green on me. i worried the heck outta them yesterday. i was spazzing becuase i thought i had to pay 1000 to them,. thats why they called me , because i requested it so i would know what i had to pay. :) as far as the other appointments, i have to wait to receive my letter  ill keep ya posted

I have BCBS of NC thru my husband's work and I had to pay $30 each time I went to the dr. before surgery and I had to pay my co-pay @ the shrink.Then after the surgery I received a bill from the hospital for $1200 and one from the dr. for $1000.00. I too am confused about insurance and all that goes along with it. I wish we had our stimulus package . Ours was supposed to be direct deposited LAST friday and we still don't have it. I had it spent already too! LOL Oh well guess that's what I get for counting chickens in the eggs! Melissa

If you need insurance help let me know! More than likely your plan had a deductible and/or out of pocket which is why you are now receiving bills. Your insurance company should have sent you an EOB showing what you owe and how it was processed - it should show if it was a copy, a deductible or out of pocket - more than likely you can also access your claim information online.

If you have a deductible only certain benefits apply to it - anything with a straight copay, like Drs visits, do not go towards your deductible... typically procedures that are done outpatient (like the endoscopy, outpatient surgery etc) you have to pay out of your pocket until you reach the 1000$ deductible. You have to check *your* plan to see what is covered under copay and what is covered under deductible. Also - since you have a deductible you will want to be aware if you have an out of pocket to meet as well. What you pay for the procedure would be what the insurance would normally pay - so even if the procedure itself costs $875, if the insurance would only pay that provider $400, then you would only pay the $400... its based on a providers written contract with the insurance company... the insurance company *cannot* tell you what it would pay a contracted provider before a procedure, the provider can thou... however after the procedure your insurance company will send you an EOB - explanation of benefits - stating exactly what you do and do not owe... you always want to look and make sure you *only* pay the provider what the insurance says you should pay.  For my RNY surgery I had BCBS thru my employer - at that time I had a $500 deductible and a  $1500 out of pocket... when I had surgery I had met most of the deductible already so I ended up paying my surgeon roughyl $260 and the hospital was $1200.  If you need any further help let me know, I worked at a major insurance company for many years and know all the insurance in and outs. You can always call customer service and ask about a procedure prior to see what benefit it will fall under. With BCBS you should be able to access your benefits, deductible and claim information online as well.

One more thing to add---be sure to find out what the individual deductible is vs. the family deductible.  For some plans, once the family ded. is met, then "that's it" for the deductible, and the insurance picks up 100% (or whatever your plan is).  Jennifer K is right---be sure to check about your specific plan---it doesn't matter w/the insurance company.  We have BCBSNC too, but our plan is $200 ded. individual, $400 family.  I'll still have my co-pay when I go into the hospital, but I won't have any add'l towards my copay, since my daughter has had some medical appts that applied to her individual ded.  I've found BCBSNC's website to be very easy to maneuver, but don't hesitate to contact their customer service for specific questions.  Good luck!

Hi,
I have Tricare Prime which is the active duty military insurance, they picked up the entire tab including all pre op testing and I never paid one penny except for the fee for the class that Southern Surgical charged.. one good thing about hubby being active duty!!! best of luck to you on your insurance claims!!

Darcie

Hey girl! Do you have the state health plan? If so, that is what I have (90/10 plan) and all in all I think I ended up paying about $1500. I think part of that was because I had the 80/20 plan when I did the endoscopy and then changed to 90/10 when that had that special enrollment period last fall. I did have to pay the difference between the endoscopy and the hospital bill.  SS will make you pay about $500 before your surgery (usually the day you schedule surgery). When you think that the surgery costs about $48,000 total; $1000 isn't that bad. I hope this helps some. I don't know the exact break down for it all, but most of it will be b/t the endoscopy and the surgery. Oh, you also have a $100 copayment for anything regarding the hospital and like someone else said, the copays don't count toward the deductible. James (my husband) has just finished all preop tests and so far we have only paid copays... we did get a bill for then endoscopy, but I didn't pay anything for it yet as they didn't file insurance.  We had to add him to my plan because his company has an exclusion policy. Anyway, I hope this helps!  Good luck moving on to the next step!

Melissa, I just had my endoscopy, and when I was making my appointment, the receptionist said, "it'll cost you 1,000 out of pocket if we treat it as an outpatient procedure, but only a copay if we call it an office visit".....I dunno what the dealio with that is, but maybe it will help you if you ask them about that....