It's actually up to each provider as to when they bill you.  Some providers will ask for the money up front.  A participating provider with BCBS will know how much the BCBS approved amount is.  If they know you have not met your deductible, they may make you pay at the time of service.  This is their right. 

 This is how my insurance works too.  thankfully I don't have nearly that high a deductible, mine is $1,500, then I pay 20% after that for the next $1,500, then the rest is paid at 100%.

With my insurance, and I believe most work this way, the clinic/hospital will take your card and copy it, and you pay nothing on the date of service.  They will bill your insurance, insurance will reply to the clinic and you that the balance has been applied to your deductible and that the whole balance is "patient responsibility", up to the point your deductible is satisfied.  After that they pay at thier rate (80%, 100% or whatever).  But ALL charges are at the insurance companies negotiated rates, so it is a benefit to you, even with the high deductible.  

I had Roux en Y Gastric Bypass done the middle of November.  Prior to the surgery, I called my insurer, Champva, and was told that the bariatric center was also calling to verify coverage eligibility.When I called,  I was told that the surgery was a covered benefit if deemed medically necessary and that there were no comorbidities needed if the BMI was over 40 (mine was). The insurance verifier at the bariatric center then called and told me that the surgery was a covered benefit and I appeared to meet all the critera so I could move forward in the process. After I completed all my nut visits and saw the surgeon, the paperwork was to be submitted to the insurance company. My doctor's office called a week later and told me that Champva does not give pre-authorization and as such I would need to sign a paper saying that if they did not cover the procedure, I would be responsible.  They also told me that it was a formality and they saw no reason why it wouldn't be covered as I met all the necessary critera.  About a month ago I recieved a letter  from Champva to the hospital and myself, saying they had denied the hospital bill and asked that it be resubmitted with the history & physical and operating reports.  I haven't heard anything further, have never heard anything from the hosptial at all.  Then last week I got an EOB saying that the doctor's charges were denied as not a covered benefit.  I called Champva and after 30 minutes of them trying to figure out why it was denied when they thought it should be covered, they finally came back and said that it was denied because it was billed as code number 43645 and that is not a covered service, but I should check and see if perhaps it was a typo because 43644 is a covered benefit. I called the Dr.s office and they said, no it was not a mistake, it was billed as such because I have a limb greater than 150, making it a different procedure code.  They also kept saying that they didn't understand why the were saying it wasn't covered because Medicare pays for both and Champva normally pays whatever Medicare pays. I was never informed that the coverage was limited to a distal procedure and the doctor's office doesn't understand why they won't pay.  Now I am stuck with a $20,000 doctor bill and if they will not pay for that, then they will most likely not pay the hospital portion either, which is an additional $36,000!  Is there anything I should know that could help me? Is there anything I can do?  Appeal?  I am overwhelmed by this and I feel that somehow someone dropped the ball.  I don't understand if there were limitations, why neither the bariatric center or myself were informed of them.  Can anyone give me some advice on what to do next?

Good Morning....

I have BCBSM, my VSG surgery was May 14, 2009.  I was told everything was covered, in January 2010 received an EOB saying I owed money, called the doctors office, was told not to worry about it, so I didn't....  just last week, Feb. 2011 received a statement from doctor saying I owe $2500.  What is the appeal process with BCBSM, is it too late?  Time limits, etc?

Thank you!

   Just wondering how long they take to get back to the Dr's office.  The request for my revision should have been faxed in Friday but it will be done tomorrow.  Naturally I want my answer yesterday.  Thanks for any insight.