Pre-approved but BTC out of network for UHC Choice PLus

I live in Columbus and was ready to schedule when I found out BTC was out of network. Someone told me that they only had to pay $1,500 maximum to have BTC do the surgery as that was the max for out-of- network. ANyone else with that experience ? Any helpful suggestions or recommendations would be greatly appreciated.

Matt.........I asked a similar question a few weeks ago and the answers varied. I was scheduled to go for a consult at Groveport and changed my mind cause it was all out of the network. I opted in fact, to go to a surgeon in PA...both he and the hospital are in network for me. I just felt that even if it was 1,500, that is money i could use elsewhere and I have heard horror stories of folks havin to pay even awhole lot more....thousands in fact. When i called they told me it would depend on my insurance...I know CIgna PPO only pays 70% for out of network , and when i stressed the fact i would like to have it in writing that it would only cost between 1,500-2,000 range of course they said i would have to wait till everyone was billed. THey are a good facility from what i have heard and read. but i chose to go where i don't have to worry about another bill....My consult is May 11. Good Luck. Remember ...better care does not necessarily have to mean more money out from your own pocket........

Thank you for the reply. What a journey this all is. LOL take care, Matt

Hi Matt, I believe it is a personal choice in this case. I have UHC and I chose to go to BTC in Yipsilanti MI, I chose this hospital and doctor carefully on did my homework well. I felt the sucurity of going someplace I had so much confidence in was worth the $1500. The BTC said they would not bill me until all other insurance claims were paid. They also said that they would work out an easy payment plan. I do not want to tell you what to do. I had my surgery at the BTC and I am very pleased. The care was excellent and my surgery went off without a hitch. The total amount they can charge you is the $1500 allowed for out of pocket for the year. Whatever you decide, good luck

Thank you Debbie. I live very near the BTC here and was very impressed with Dr. Stelmack. Also, the timing of the surgery would be good for summer. Appreciate the reply. Matt

Hi Matt, I had my surgery at BTC in January... I have not received the final bill yet...but i was told the same thing Debbie was told... My insurance is Medical Mutual of Oh. and hospital was in network but doctor was out... I have seen the prelimainary billings and as i calculate there shouldn't be much left for me to pay. I had Dr. Stelmack. True it is a personal decision... but for me it was well worth whatever the final bill will be. the cooperation and care from everyone is excellent. It was important for me to have a facility that focused on/specialized in bariatrics. Good luck as you ponder... Venita

matt--dr stelmack is the greatest!!!! i had my original consult with him in july last year--found out they were going out of network for my med mutual and so i moved to ypsi to btc to dr poplawski--also an awesome person--and then found out that i would have to pay up front to go there after approval--if i went to groveport; even tho out of network- payment goes to them --well- i chose dr stelmack and figuredthat the money out of pocket was worth it--knowing that that is all they do thetre and the staff and everyone were great!!!! i haven't seen what my ins pays yet as my surgery was just 4 weeks ago--but i will find a way to pay it! email me privately if you wish-- and if you are looking for an angel - i would be happy to volunteer-- good luck whatever you choose! margo - open r n y 3/26/04 dr stelmack- groveport btc 230/210/120

Yep, I had to pay the $1500, but it was totally worth it. I would've paid $5000 if I had to, lol. ~Jessi

I also went to BTC in Groveport last June - Dr. Stelmack was my surgeon also. Let me just say that if you choose to go there, you will not regret it. I had Aetna and both BTC and Dr. Stelmack were out of network for me. I ended up with about 1,500 out of pocket. However...talk to your HR department - somebody very familiar with your insurance because you could, depending on your policy, end up with a larger bill. My policy stated that I would be responsible for the 30% of "Reasonable and Customary Charges" up to my out of network, out of pocket maximum. However...I would also be responsible for any differences between what was billed and what insurance designated as "Reasonable and Customary" and there is no limit on that. However, I think BTC has a way of getting insurances to pay the majority of the fees based on the medical necessity issue. Aetna ended up paying almost 98% of my expenses. Good Luck.

have you tried finding a facility or doctor that is in your network? I mean if they have pre-approved take them up on it know what I mean good luck on whatever you decide and you are in my prayers.