pre paying what insurance doesn't cover
Sorry it this was already asked but...
I got the call from the "insurance guru" at my sergeon, Dr. Georing's office that My insurance company contacted her and let her know I've been approved! It was just 15 days since she sent in all my paper work.
But now I've got all these qustions flying trough my brain. The woman that called me from the Dr. office talked to me quickly about meeting my deductable before the surgury but since I was driving and also SOOOO excited about my approval I'm not sure if there is more to it than that or not. I know my deductible has either been met or just about met for the year because of my monthly GP visits and a dermatologist and also the 2nd part of my phyc evaluation at the beginning of the year, but I'm now worried if they will ask me to pay the 20% or whatever it is that the insurance don't cover, before I have the surgery. This was not the case with my other 2 surgeries (removing my gallbladder and an ovarian cyst) and I'm not sure if it is with this one or not but as of right now I'm not positive about it or not. I probably wouldn't have gave it a thought except my husband (the party pooper) started asking me where I was planning to come up with the, possibly $4000 or $5000 (hopefully insurance don't leave us with that much to pay) in a little over a month. I told him how Deb just mentioned I would have to have our deductible met, but I really couldn't honestly answer the rest of his question. I know we could do maybe $2000 or less if we REALLY were forced to pay up front. and we might be able to swing the $3000 to $5000 that we may be looking to have to cover, but it will be REALLY tight around our house for a while!!! It would be so much easier to pay the few little bills like $300-$400 here and there for anesthesiologist and radiology and what not, and then pay the other couple of bigger bills like the sergeon and the hospital off in like 3-6 payments or whatever, so we didn’t just drowned in it all. That’s how I paid my other two surgeries. But honestly, even if I had to come up with $5000 before my surgery I would!
Has anyone else ever had to come with big money ($3000-$4000) out of pocket before surgury when you've been pre approved by insurance?
I got the call from the "insurance guru" at my sergeon, Dr. Georing's office that My insurance company contacted her and let her know I've been approved! It was just 15 days since she sent in all my paper work.
But now I've got all these qustions flying trough my brain. The woman that called me from the Dr. office talked to me quickly about meeting my deductable before the surgury but since I was driving and also SOOOO excited about my approval I'm not sure if there is more to it than that or not. I know my deductible has either been met or just about met for the year because of my monthly GP visits and a dermatologist and also the 2nd part of my phyc evaluation at the beginning of the year, but I'm now worried if they will ask me to pay the 20% or whatever it is that the insurance don't cover, before I have the surgery. This was not the case with my other 2 surgeries (removing my gallbladder and an ovarian cyst) and I'm not sure if it is with this one or not but as of right now I'm not positive about it or not. I probably wouldn't have gave it a thought except my husband (the party pooper) started asking me where I was planning to come up with the, possibly $4000 or $5000 (hopefully insurance don't leave us with that much to pay) in a little over a month. I told him how Deb just mentioned I would have to have our deductible met, but I really couldn't honestly answer the rest of his question. I know we could do maybe $2000 or less if we REALLY were forced to pay up front. and we might be able to swing the $3000 to $5000 that we may be looking to have to cover, but it will be REALLY tight around our house for a while!!! It would be so much easier to pay the few little bills like $300-$400 here and there for anesthesiologist and radiology and what not, and then pay the other couple of bigger bills like the sergeon and the hospital off in like 3-6 payments or whatever, so we didn’t just drowned in it all. That’s how I paid my other two surgeries. But honestly, even if I had to come up with $5000 before my surgery I would!
Has anyone else ever had to come with big money ($3000-$4000) out of pocket before surgury when you've been pre approved by insurance?
I've always just paid the bills (on a payment plan of course) when they came, I have never had to pay interest. If it worries you, how about setting up a savings account...won't accrue that much interest but anything helps. When they come, just make a lump sum payment from the account. Just my two cents...
Belles_Mome
on 4/8/10 3:31 am
on 4/8/10 3:31 am
If they ask for the coinsurance (%) upfront rather than a flat copay, and you feel brave enough contact your insurance company. A lot of companies do not permit their contracting providers to ask for the coninsurance up front - the rationale being that until the claim is paid you have no way of knowing what the member iablity will be.
For contracting providers the member liablity would be based on the fee schedule (not the billed amount) and the member's out of pocket maximum - since the OOP max is dependent upon which claims have already been paid it is really hard to estimate - and even harder to get back if you have paid the dcotor too much.
For contracting providers the member liablity would be based on the fee schedule (not the billed amount) and the member's out of pocket maximum - since the OOP max is dependent upon which claims have already been paid it is really hard to estimate - and even harder to get back if you have paid the dcotor too much.
Thanks so much for everyones input. I did get an answer. The insurance lady called me yesterday from the surgery group. Here's what she told me: She found out my out of pocket Max w/ my insurance is $1500/yr (sooo relieved!) but the hospital also asks for about $500 up front for somethings (not sure what they are yet) that insurance usually don't cover and then also the dietion also needs to be paid for all of her post opp visits before hand too, which is about $200 so all and all the Max I'd need to come up with is $2200. I think I can handle that, but theres more good news, even though they're not showing up w/ my insurance company, I have paid or will be getting bills for 3 GP visits so far before my surgery, also the 2nd half of my psych evaluation took place after the new year and then I had a visit to the dermatologist so I'm guessing once I have all of those added up it will be something like $800 or so, here's hoping the insurance gets all or most o them applied toward my deductible before my surgery!