surgeon fees and insurance pay out

hello

i'm 7 weeks out from rygb performed by Dr. Brolin @ UMC Princeton on jul 12, 2010. Still not back to work yet, and starting to worry about finances. but, that's another story.

i have horizon blue cross direct access. Dr. Brolin is an "out of netwrok" doc for me, but was the best choice for my precedure.  I am begining to appeal my insurance payment, and I need some back up info from everyone.

What was your surgeons fee?
What did your insurance pay?
What did your insurance consider the "customary" or allowable fee?

any other financial advice is welcomed!
thanks!
Terry

hi there -- i do medical billing -- the surgeon's fee is whatever the surgeon wants to charge -- your insurance pays whatever their contract is with the participating dr -- so you would have to find out from your surgeons office what their seperate 'fee schedule' is with horizon -- because you are 'out of network' it also depends upon your individual policy and what your deductible is with your plan -- AFTER you pay your deductible then it goes into what 'percentage' your policy covers for out of network benefits -- remember, each policy is different -- direct access is an HMO policy -- it doesn't say HMO on the card anywhere, but it is -- good luck -- if i sound confusing to you, just ask me again to explain things better

roberta

I have no real answer for you except I wish you all the best - and know we're here for you !!

Hi Terry, I am also appealing BCBS of Mn (uses BCBS Horizon to help determine local "customary and usual" fees). And I also used Dr. Brolin. Did you get any additional info to help you with your appeal ? back up info?

Let me know if you were successful with your appeal. This is my first post on OH. I just started the appeal process. Any advice?
THanks,
Tara