Insurance Coverage ****Urgent!

I received a letter from my insurance BCBS Horizon traditional plan that says that they have determined that my lap band surgery is medically necessary. But they write the the surgery charge amount as $15, 000.00 and the estimated reimbursement is $5, 162.00. Now my question is: Does this means that they only will pay a partial amount for my surgery? Why? Have anyone received a letter like this one? Please help me!

Isa~ I wish I had an answer for you, I have Horizon BCBSNJ HMO, and I haven't been approved yet. I have heard that some people had pretty hefty "co payments", but I didn't know it might be the major part of the cost of the surgery? I hope someone can answer here... I am curious too. Michelle

Can not be sure but from the info you provided. They are paying a % of the reasonable and customary fee for the procedure and not what your doc is charging them. So the answer is yes they are are only paying a partial amount.. The amount you have left to pay is the co-insurance. . Best to call them for a complete explanation.

my husband just had his surgery on 5/22/06 -- he was approved in 2 weeks -- when we got to the hospital the day of surgery is when we found out he had a $300 co-payment -- nice time to find out -- i guess we should have called and asked questions first he has BCBS horizon of nj good luck Roberta

Hi, I have BCBS and used a doctor who participates and was charged nothing at all. Usually by the doctor agreeing to participate in the insurance plan, they agree to accept what the insurance company's going rate for a proceedure is. You should call the doctor's office and insurance company for clarifcation first though. It sounds to me like they plan on paying the doc 5,162 for the surgery and once again, if he works with them, then he knows and agrees to that payoff. Hope this helps a little, good luck to you!

Heather~ I like your answer, since I am using Dr. Trivedi in the same group, and I also have Horizon BCBSNJ! Good news. I haven't been approved yet though, I am just hoping to cross that bridge, then I can deal with costs. I met the Dr. today, and now I am waiting to get a date and for the insurance to approve the surgery....nerve racking stuff....