Question:
Considering paying for my own pre-op tests
I've been jumping through hoops for the last three days trying to get a straight answer from the PCP, the surgeon, and the insurance company, on what it takes to get proper approval for the pre-op tests. The surgery itself is approved, but nobody can agree on the test approval procedure. The insurance company simply insists that the test can't be done at the hospital, but must be done at a "standalone facility." But they can't provide me with a list of any such facilities that can actually perform the tests. The one test I was able to schedule (the Chest XRay) I had to cancel because the place had a 300 pound limit. I'm tempted to just bag the insurance mess on these tests and just self-pay at the hospital, but I have no idea what they cost. Can anybody give a ballpark figure on the costs for these tests: Chest XRay. ECG (electro cardio gram?). Pulmonary Function Test. Arterial Blood Gas. I would pay upwards of $1000 out of my pocket just to be done with it. Over the last three days I've given nearly that much in my own billable time as it is. — Jim F (posted on March 5, 2003)
March 5, 2003
HUGS - I'm totally geeting the runaround, so I know what you mean. I have
gotten the cardio, ultrasound (my surgeon requires) out of the way, but I
can't get a straight answer with the psych. I'm ready to pay out of
pocket, but everyone keeps advising against it. In the most idealistic
sense, the more we all hold out and make insurance pay - we pave the way
for others to go through the process. From a practical standpoint - it
depends what is best. Me, I have to go to a VERY crowded program and wait
months to even be seen - so I might as well go through the steps and not
shell out money yet. But yes, I do waste time on it, and probably am not
being cost effective. Prices vary. For the psych - I have heard anywhere
from $200 - $600, with the cheapest being "therapists". Of
course, I have yet to find one. I ended up not having an ECG but had a
thallium tracer test with a presantene (sp?) stress test. OMG, I don't
even want to know how much THAT cost. X Rays are not too expensive. You
can just call an XRay place and ask. Same with the lab. Lab work is not
too bad if you don't want INSTANT results. Don't have a price range to
quote though. Now do you hae a date and this is pre-op testing? (vs. all
the screening stuff) If so, they should be working with you more. I hope
that things work out. I swear, this whole journey has been more fighting
than I envisioned. Hang in there!
— w8free
March 5, 2003
Hi Jim, sorry for all the trouble you are having. Where do you normaly
have blood work done at your PCP's office? Most PCP's have an EKG machine
in the office or clinic. If I were you I would call the insurance company
and see if your local hospital is in there net work could do the EKG,
pulminary test,and chest x-ray. not only that, let the insurance company
pay,thats what you pay the premiums for. Your surgeon or pcp will have to
write an Rx for you to have the test done anyway. Costs vary all over the
country, so it would be hard to guess at a price. Good luck
— wizz46
March 5, 2003
Thanks. These are pre-op tests (the surgery is a GO for April 16th assuming
I can get all these tests out of the way.) The actual blood tests (labs)
are being done at the PCP's office, but AFAIK they aren't set up to do the
EKG, and I know they don't do the PFT or the ABG. The insurance company
says they WILL authorize the tests to be done at the hospital if the
surgeon gets a pre-approval, but the people at the surgeon's office say
they don't want to do this, since it should be the PCP's job. Again, just a
complete runaround. I may just go ahead and schedule the tests at the
hospital and plead ignorance if the insurance company questions it. I just
don't have the time to waste playing any more ridiculous phone tag games...
— Jim F
March 5, 2003
My pre-op tests were $1673 and that included a $50 charge for dietician. I
also was charged $125 for the pulmonologist to interpret the PFT. I had
Chest X-ray, EKG, Upper GI (barium x-ray), pulmonary function, 10,000 blood
tests (an exaggeration but not by much!) and the arterial blood gases.
<p>From what I have read my hospital charges for the surgery and
stuff were very reasonable so I have no reason to assume these were too
high. Besides BCBS paid every last penny of the charge and if they
consider it okay then you know it must not be too high.
<p>You should be able to get everything done at your PCP's office but
the pulmonary function test and arterial blood gas and Upper GI, if you
need it. Usually only hospitals have the facilities and ability to handle
these things. Just tell insurance to tell you where you can get these
things done. They may just find that those few things can be done anywhere
else and then agree to it. This should not be a big deal to get resolved
and why bother to lay out the money. If you are going to gamble then at
least get everything that you can get done at your PCP's and then worst
case you'd just have to pay for the rest. Trust me the blood work was by
far the biggest cost, at least $800 so if you can get that paid for and the
x-ray and EKG you'd only be looking at way less than $1000. This assumes
the costs in your area of the country are similar to WI. Good Luck! Chris
— zoedogcbr
March 5, 2003
My pre-op tests were done at the hospital where my surgery is being done
at. They billed my insurance CO 1600.00. However my insurance CO. Paid
less than half of that when they settled the bill. They bill it
outrageously high. I would see if your insurance co. would let you do your
X-rays at the hospital and maybe have your stuff done elsewhere. Best
Wishes
— Heather S.
March 5, 2003
Thanks for the info Chris and Heather. This helps a lot. I have all of the
tests scheduled except for chest XRay, ECG, ABG, and the PFT. If I don't
get straightforward answers by the end of the week I'm just going to go
ahead and schedule these to be done at the hospital.
— Jim F
March 5, 2003
When i had mine done i didnt know that i might need preapproval. Well, my
ins tried to not pay saying there wasnt a reason i got them done. I said
hello i had surgery. And the girl at the insurance co said she would take
care of it. I would just get them done by the hospital and tell them they
need to pay them if they deny them. Then appeal if you have to because it
is necessary, it isnt like your hospital isnt covered to do everything else
right, so why cant they do the preadmission tests?
Thats a crock if you ask me, it isnt like they are going to say everything
is ok to have surgery if it isnt.
— rachel W.
March 5, 2003
Thank Rachel. I'm going to work on this today and tomorrow, and if I
haven't made any progress I will go ahead and do as you suggest. <p>I
am one down and three to do anyway. Yesterday I called the place that does
the chest xrays. I asked them if there was a weight limit, and after
conferring for a few minutes, they told me the limit was 300. I'm 380 or
thereabouts. Today I just said the heck with it and went down there, and
they gave me the XRays with no questions asked. What a joke.<p>
So now it's down to just the ECG, the ABG, and the PFT. If worse comes to
worst and I have trouble with the insurance company, I'll just suck it up
and pay for it myself.
— Jim F
March 6, 2003
This should be my final update to this situation. Today I went ahead and
scheduled the AGB and PFT at the hospital. Naturally later in the afternoon
the PCP's referral office finally located a pulmonologist for me that they
could refer to. The only remaining consult to arrange now is for the ECG,
and I'm waiting for a callback on that tomorrow. Now I just have to
actually DO the tests...
— Jim F
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