BCBS of MS/TX

I have BCBS of Mississippi, but live and work in Texas.  The surgeon I'll be using (we send in for approval in a couple of weeks!) is here in Texas and is "out-of-network", but they said they can do it in-network or something.  The whole thing is confusing to me.  I've asked the lady in the office there and she said the only thing I will have to pay is my out of pocket (which is $1500) for the surgery.

Everyone I talk to thinks this is a lie and that insurance will screw me over saying I owe more or that they don't cover anesteshia and little odds and ends like that.

Anyone have issues or insights that you think might help?  I'd appreciate it

:-)

It is your surgeon who either accepts what your insurance pays or not.  You should get confirmation he has agreed to accept and charge you only the in-network pricing that your insurance is willing to pay; plus your $1,500 co-pay out of pocket expense and no more.  Remember this is just his fees.  You need to also be aware of the anesthesiologists fees, hospital operating room, etc.  All of these depts. need to be identified as either in-network or out of network before you have surgery too or you could end up owing for them also at out of network costs.  I would call the insur co and ask them if your maximum out of pocket expense also covers when you use out of network benefits.  The max out of pocket expense rule may not apply to out of network costs.  I'd ask them to send you this information in writing also.  I had an unpleasant surprise with my BCBS/Illinois policy when I went for my psyche eval.  The doctor was listed on their PPO Provider list (in-network) but that doctor's office kept telling me the doctor wasn't an in-network provider, only the group the doctor was part of.  Sounded fishy to me so I called.  BCBS/Il told me I only had to pay my $15 co-pay but literally 5 minutes before appt time, BCBS called me back to say, "Oops, sorry.  We made a mistake."  Thanks alot; that one cost me $245 on the spot or no psyche eval.  I feel very ripped off by both the doctor and BCBS as neither admits to the error.  I could fight it but in the long run, it's $245.  Not worth the effort or expense of my time.  But that doesn't mean I won't share my experience with others.  Beware of anything verbal.  Your insurance company has to provide you the info in writing if you request it and your doctor should if he is legitimate and honest.  Don't allow yourself to remain confused.  Arm yourself with the knowledge you need to make an informed decision.  You will find yourself in this position more than once as you make this journey. 

Thanks!  That was pretty much what I was wondering and I definitely need to ask them.  I had the same thing with my psych exam---I had to pay for the visit myself, insurance didn't cover it, even though it was in-network.

I will ask the office as well as the insurance my questions, but let me clarify some things.  I'll have to pay my max out of pocket for the doctor's office, but will I, in addition to this, have to pay the anestesiologist, hospital (for the room and overnight stay), etc?!?!  Will I only have to pay those as well if they're out-of-network?  I'm new to the whole insurance thing, but I thought my max out of pocket is all I have to pay for the year regardless or something.  I don't want to be clueless on this :-P

I would ask for benefits in writing.  I've heard of people having to pay more than they expected to because insurance didn't cover the "extras". 

In most cases,(remember I don't know your specific policy) most BC/BS policies have what they call Blue Card.   Can I ask you one questions.  Look at your blue cross card, at the top does it have a suitcase and say PPO????  that would be what I needed to know then I can give you additional information

yes ma'am, it does.  there's a suitcase and in it it says PPO.