Question:
Has anyone had their surgery costs reduced due to PPO Reduction?

I just got an "Explanation of Benefits" letter from my insurance company. It listed the surgeon's fee as $6000 and the allowed amount of about $1800. My share of cost was 20% of the $1800. It seems my surgeon has a PPO Reduction Contract with my insurer that allows them to set the allowable cost for any given procedure. I assumed I would be responsible for the difference between the $6000 and what the insurance paid (sticker shock to say the least!) but after talking to the insurance company and the doctor's office I realize that the surgeon is contracted to accept the reduction amount. $1800 for a $6000 bill? I was stunned. That sure reduces my 20% cost. Has anyone else had this happen? Thanks,    — crishsapig (posted on January 24, 2002)

January 24, 2002
It sounds like your surgeon is an in-network provider. If os, then yes that's the way it works. I'm amazed at how much write-off happens. I once had a $30,000 hospital bill reduced to about $7,500. Now if the surgeon were out of network you would have had to pay the difference. It's a powerful incentive to stay in network.
   — garw

January 24, 2002
I thought I was going to pay a lot more but I get the same deal and will only owe the surgeon around $200! After reading all the insurance fights here I feel soooooo Lucky!
   — Michelle F.

January 24, 2002
What your insurance told you is correct, you only owe 20% of the $1800. My insurance was even better. They had a reduced fee and then my surgeon accepted that amount and didn't bill me for the remainder which was my part. They just wrote it off. I feel very lucky to have been so well taken care of by my insurance. I am glad some insurance companies realize WLS is actually worth covering! Good Luck!
   — purdue_1993

January 24, 2002
Yes. My surgeon was an in-network provider as well as the hospital that I went to. My bill from the hospital was $17,225.38. You know what they paid out?! $1,400!!!! That's it. And the hospital accepted cause they are network providers.
   — tmrivas

January 25, 2002
Welcome to the world of PPO's!!! Having worked in the health insurance field for 20 years, people dont realize the mark up that hospitals and doctor have. By these providers involvement in a PPO, it gets them there money faster from the insurance carriers and helps patients pay a LOT less for the care. My charges have totalled $28000.00. Since I made sure ALL of my providers were in the PPO network, the insurance ended up paying about $7000.00 for my total surgery. The rest of the charges are written off by the providers. I only ended up paying $200!!
   — Patty H.

January 26, 2002
My insurance company only had to pay $14K instead of the $25K quoted cost. PPOs definitely get a major break!
   — Lisa B.