Question:
Does anyone know how much their insurance paid?
I receive my EOB from my ins. yesterday and was shocked at the little amount they paid for my surgery now I feel guilty that my Dr. didn't get what he deserved.I have heard on here that the surgery is like $32,000 Is this true? My hospital was $15,000 and the Dr billed $6,000 The hospital received $6,000 and my Dr. received only $1,600. Everything has been paid for as of now. — lisab. (posted on May 3, 2003)
May 3, 2003
My total cost was 18 thousand .. Cigna paid 80 %
— ruthie
May 3, 2003
My bill was something like 80k (5 days in the hospital). Blue Cross paid
all but 3k of it.
— susanje
May 3, 2003
Lisa, dont worry about it. Your doctor knows what he is going to be paid by
the insurance company and does the surgery for that price. He needs to
renegotiate his contract! It's called the contracted rate. My insurance
company paid 80% of the contracted rate until I reached $1500.00 out of
pocket then they paid 100%. My doc got 4,000+ out of the 6,000 he billed.
Hope this helps. :-)
— Pizofret
May 3, 2003
BTC billed BCBS 48,000 and BCBS paid 12,000. Doc billed them 5,000 and I
think BCBS paid him 1400 or 1500.
— Kris T.
May 3, 2003
My insurance co pay for inpatient is $100.00. That's it. It depends on the
policy your employer pays for.
— Sarah H.
May 3, 2003
Like you, I am almost embarrassed to go around my doctor. I know his fee
alone is 6000. My group has a set price with everything but the pre-op
testing included. Well the entire cost (except pre-op which was 5000)for
my surgery and hospital was over 18,000. UHC only paid what they call the
contracted rate and it was 6,300. No wonder a lot of hospitals inmy area
have stopped taking UHC. It is pitiful and they can't bill me more. That
is all they get.
— Delores S.
May 3, 2003
My total charges with pre-op testing was $26,025 and BCBS paid every last
cent. Technically none of my providers for the surgery have contracts with
BCBS, so I could have been left with a whopping bill. The surgeon's bill
was the one I was most worried about and that I was able to verify before
surgery would be totally covered.
<p>The big question here is do these providers have agreements to
accept whatever your insurance pays? If not, you could be in a heap of
bill trouble. If you have a HMO, you are fine. If you have a PPO and used
all in-network providers, you are fine. If you have a POS plan, like I do,
and none of these providers have contracts with BCBS it could be a mess. I
am assuming because the reimbursement is so low that it is based on a
contract between them and your insurance. I've never seen reinbursements
on POS policies be that far off. Maybe 25% but not over 50%. So most
likely you are fine.
<p>Like someone else said, if these people have signed contracts with
BCBS then they knew what they were going to be paid. However, I do agree
with you that these payments seem very substandard. $1,600 for a surgeon's
fee especially for this type of surgery in insane. My LAP gallbladder
removal in 1994 was like $1500 and that was totally acceptable to BCBS
because they paid it all. I would be thoroughly embarrased is that's all
my surgeon was paid especially with the extensive amount of follow-up care
I have had due to problems getting my incision to heal. By 10 weeks I had
been in there close to 10 times. My surgeon was paid $6000, so I have
absolutely no guilt with all these visits. He has never complained and
when I said something he just said don't worry about it, that's just how
some of the post-op recoveries go.
<p>My hospital bill was $13,870 and paid in full also.
— zoedogcbr
May 3, 2003
I have Kaiser they paid 100%, $35,000.
— ~~Stacie~~
May 3, 2003
My insurance BCBS paid 100%, I never knew what the cost was until 6mo after
the surgery when I recieved a BCBS statement and it covered $46,311.17 to
BTC. WOW, im glad my insurance paid for this one :o)
— Sandy M.
May 3, 2003
I have BCBS Health Options. The Hospital charges where $34,000 and
insurance was contracted to pay $4500. The surgeon billed about $5,000 and
was paid $1600. I had no copay for inpatient. I didnt pay for anything
except office visits.. Thank goodness for insurance!!
— Dawn E.
May 3, 2003
Your surgeon got the contracted rate. On the EOB, the billed amount cold
be a million jillion dollars, so don't really pay any attention to that. I
work for a healthcare system that is self insured, and I recall the medical
director saying that, relatively speaking, $1000.00 per hour for a surgeon
is fair reimbursement. We have to pay 10%, and that is 10% of the
contracted rate, not the billed rate, thank heavens! I had someone at the
office look at the claims for my surgery, done 6 months ago, and with all
the charges - the anesthesiologist, the hospital, the surgeon, etc, the
total cost was about $13.000, so we would have paid $1300.00 out of pocket.
The billed charges were well over $30,000.00. So don't feel guilty - your
surgeon and everyone else was paid the rate they agreed to!
— koogy
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