HelP! I need Insurance Decyphering

Thank you in advance,

I have been in contact with the Insurance/billing person who is in my WLS Doctor

I wanted to know the breakdown of costs to me after surgury so I can have all my bases covered

I didnt get what I needed I got this:

"the entire amount will be paid to the surgery center (4000) or less.

their claim will process first and will absorb your emaining out of pocket.

Dr Currys claim will process second andwill witll get paid at 100% (nothing on your end)

Dr Currys fees will be billed @ 4200.00 We will get paid our contracted rate which is 110% above the

medicare rate."

Someone please help me understand~

Does this mean I have no cost?

does it mean there will be costs later?

I am just confusing myself~~~

thank you so much for any help

I honestly think the person didn't actually answer your question. You need to ask specifically what your part of the bill will be. It looks like to me they just gave you a list of the steps that will happen....and poorly written on their part, LOL. Sorry I'm not much more help!

I thought that too!!!

Based on their response it appears you do have some out of pocket that could be due on the surgery center portion after that everything will be paid in full. You will need to clarify with them or Medicare as to what your remaining out of pocket is for this year. Sorry it's been about 15 years since I processed insurance claims but that's my 2 cents.

You need to know what your out of pocket on your policy is, and then if you have met any of it this year. Best thing is to call your insurance company. If you uaven't met your out of pocket, you would at least owe that.

Go to your insurance company's website and find out what your maximum out of pocket is, as well as your coinsurance percentage. 

For example, I had a 2500 out of pocket with a 15% coinsurance. So after I met my deductible, my insurance paid 85% of allowable charges and I paid 15% until I had paid 2500, which satisfied my maximum. Then insurance paid claims at 100%.

If I was you I would ask the billing person, how much is my out of pocket expense?  Insurance is a nightmare.  Good luck figuring it out.

Call your insurance company and ask. Everybody's plan is different so we can't necessarily explain or decipher.