Question:
Has anyone been hit with a huge medical bill because your surgeon charged more than

the "reasonable and customary" amount the insurance covers? I have Illinois BC/BS PPO and they will pay %90 of reasonable and customary, but they won't tell me how much that is. I don't want to go into surgery without knowing what to expect to be paid for and what I will be responsible for. Has anybody been approved like that and then ended up with a large bill?    — M B. (posted on December 6, 1999)

December 6, 1999
If you use a network surgeon, you should only be responsible for your percentage of the allowed amount. A contracted provider cannot balance bill a patient if they have agreed to accept assignment. Meaning, that if you choose a "contracted provider" they MUST accept the 90% of the allowable and you would be responsible for your 10% of that amount. If you chhose to use a non-contracted provider, they may balance bill you for any amount over what your insurance pays, and they are under no obligation to even bill your insurance for you. Were, I you, I would try to find a surgeon who has a contract with my insurance carrier. Good Luck!!
   — Morgan B.

December 7, 1999
My surgeon isnt part of our network so if the insurance doesnt pay more I have over $5,000 to pay.
   — Laurie B.

December 29, 1999
I am with BC of Calif/thru IBM. The surgery will cost $15,000 (Dr fee),out of this I will be charged $3,800 because she is above the normal cost for the area. Dr. Estarkhie said she will not do the surgery and loose money. We have gone too far, surgery is Jan 11, I don't feel that we can back out now.
   — Kay M.

December 29, 1999
Our doctor is on IBM's list for Vascular doctor but they do NOT have a category for Bariatric. I could not get any information from BC about who is on their listing for bariactric for this area. I have a feeling that we are all pioneers... in another five years this will be a common surgery.
   — Kay M.