Reasonable & Customary for Surgeon Fee?

Hi All,

I had a lap band a few weeks ago, and have Anthem BCBS in Ohio.    Anthem allowed under $1000 for the surgeon fee.   Because the surgeon is out out of network, I'm paying the balance.   I have no complaints, the surgeon and practice have been wonderful!    The hospital & anesthesia was in in-network. 

Just wandering what other insurance companies have 'allowed' for the surgeon fee, to see if it's worth appealing after the fact.

Thanks!

I can tell you appealing on the back end about out of network payment will probably get you no where.  Its the members responsibilty to use in network providers to reduce the out of pocket expense by the member.   Unless, there were no providers in network for you to use then you might be able to appeal that but should probably have been done on the front end before surgery. 

Each insurance company has different fee schedules so that might not be a answer you could get