BCBS NC Payments
Hi all. I had lap RNY surgery December 15th and have BCBSNC insurance. I'm not really sure how to interpret some of the billing analysis statements that I've gotten from them. I thought that my out of pocket costs would have been somewhere around $7,000, and it's really turning out to be around $10,000, and for the life of me I can't figure out what they're paying. So many of the analysis stateents show that billed costs are being applied against my deductible (of $5000) and they're not paying anything. Is there anyone out there who's dealt with BCBSNC and can give me advice on how to handle this?
Hi Cheryl -- did you surgeons office have a financial aid counselor to help with getting the surgery approved? Maybe they could give you some advice since they usually determine what your deductable is and how much out of pocket is to be paid. I paid all of mine up front prior to surgery. Also, if you have the cash, you can work a deal on the hospital expense too. I received a 20% discount. Good luck!
It works this way:
1. The Providers bill whatever amount they deem appropriate = Amount of bill column on EOB
2. BCBS has a negotiated price (if they are in-networkBCBS Providers) with the Provider that says how much total money they can actually receive either by you, them or a combination. = Amount you do not owe column
3. BCBS subtracts any deductible and copay amounts that you owe and pays the Provider the rest. = Amount paid to BCBS column
4. Your copay and deductible = Amount Provider may bill you column. It is customary that you will have a deductible and a co-insurance usually around 20% of the allowable charges (see number 2) up to a certain maximum out of pocket. The specific amounts should be displayed on your policy. For example, if your deductible was $5,000 and your copay was 20% up to $7500 max out of pocket then you would pay the first $5000 of the bill (after any write offs for negotiated price). BCBS would then pay 80% of the balance and you would pay 20% until you have paid $2500 ($7500 max out of pocket - $5000 deductible = $2500). Now, it may take several different Providers bills for you to meet all these amounts. If the first few claims that were sent to BCBS did not add up to the $7500 then they would just keep adding them together until they do.
You need to call BCBS and have them explain your benefits to you. When did your plan year for them start over? In my case, I still had some co-insurance from one year to pay after paying the deductible and then my year started over and I had to meet the deductible and co-ins all over again meaning I paid all these amounts twice as the benefit years overlapped. My out of pocket is $7500 so paying that twice was painful!!
Once you figure out how much you owe, contact the Providers and work out a payment plan if need be. As someone stated, if you can pay them off now, they often offer a cash discount off the amount you owe.
Good luck! This can be very confusing!!!!!!
1. The Providers bill whatever amount they deem appropriate = Amount of bill column on EOB
2. BCBS has a negotiated price (if they are in-networkBCBS Providers) with the Provider that says how much total money they can actually receive either by you, them or a combination. = Amount you do not owe column
3. BCBS subtracts any deductible and copay amounts that you owe and pays the Provider the rest. = Amount paid to BCBS column
4. Your copay and deductible = Amount Provider may bill you column. It is customary that you will have a deductible and a co-insurance usually around 20% of the allowable charges (see number 2) up to a certain maximum out of pocket. The specific amounts should be displayed on your policy. For example, if your deductible was $5,000 and your copay was 20% up to $7500 max out of pocket then you would pay the first $5000 of the bill (after any write offs for negotiated price). BCBS would then pay 80% of the balance and you would pay 20% until you have paid $2500 ($7500 max out of pocket - $5000 deductible = $2500). Now, it may take several different Providers bills for you to meet all these amounts. If the first few claims that were sent to BCBS did not add up to the $7500 then they would just keep adding them together until they do.
You need to call BCBS and have them explain your benefits to you. When did your plan year for them start over? In my case, I still had some co-insurance from one year to pay after paying the deductible and then my year started over and I had to meet the deductible and co-ins all over again meaning I paid all these amounts twice as the benefit years overlapped. My out of pocket is $7500 so paying that twice was painful!!
Once you figure out how much you owe, contact the Providers and work out a payment plan if need be. As someone stated, if you can pay them off now, they often offer a cash discount off the amount you owe.
Good luck! This can be very confusing!!!!!!
Thanks, The BCBS analysis doesn't distinguish between the amount that is applied to my $5,000 initial out-of-pocket deductible and the additional 40% that I have to pay as co-insurance. I'm not sure when the 40% kicked in based on their statement, nor am I sure what my maximum co-insurance amount is. I'll give them a call.
I'm going to contact the hospital and find out if they will offer a discount for cash. I didn't negotiate these prices, and some of what they charged, and even the allowable amounts, seem very unreasonable. My initial hospital bill was $47,800 and BCBS disallowed $28,400. That still leaves a $19,400 hospital bill. Outrageous, I was there 2 nights.
I'm going to contact the hospital and find out if they will offer a discount for cash. I didn't negotiate these prices, and some of what they charged, and even the allowable amounts, seem very unreasonable. My initial hospital bill was $47,800 and BCBS disallowed $28,400. That still leaves a $19,400 hospital bill. Outrageous, I was there 2 nights.
Unfortunately, it is not up to you to negotiate the fees. That is a contract between the Provider and the Insurance carriers.
40% co-ins seems really high to me. I would double check all that with BCBS. Keep in mind, there will still be bills from the Anesthesiologists, maybe Radiologists and of course your Surgeon. My stay at Rex was around 35,000 before any adjustments for 2 nights so that sounds about right. Prior to admission, Rex went over all this with me so that I knew how much I would owe. They verified what my remaining deductible and co-ins was and gave me the opportunity to pay all or part prior to surgery. Not sure where you had surgery but my experience with the locations I have dealt with (sons have had multiple surgeries at WakeMed and Duke), they usually like to let you know up front.
40% co-ins seems really high to me. I would double check all that with BCBS. Keep in mind, there will still be bills from the Anesthesiologists, maybe Radiologists and of course your Surgeon. My stay at Rex was around 35,000 before any adjustments for 2 nights so that sounds about right. Prior to admission, Rex went over all this with me so that I knew how much I would owe. They verified what my remaining deductible and co-ins was and gave me the opportunity to pay all or part prior to surgery. Not sure where you had surgery but my experience with the locations I have dealt with (sons have had multiple surgeries at WakeMed and Duke), they usually like to let you know up front.
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