Question:
I have bluecross/bluesheild 80/20 PPO, BTC said I dont have to pay my 20%.

Does anyone know if there are any additional charges? If so what and how much are they for. Thanks    — Krista S. (posted on March 20, 2003)

March 20, 2003
Hi Krista! It sounds as if BTC is willing to accept the allowed amount as payment. However, I have to ask. Is your 80/20 pertaining to office visits or hospitalization? Because in patient stays are generally covered at 100%, as long as the Dr. is a PPO Dr. or you have a referral from a PPO Dr.(I use to work for BCBS) I have BCBS Community Blue and it is a PPO. I had to pay for my Psych Consult($200) upfront and was given a receipt to submit to BCBS for reimbursement.( I sent it I am still waiting) I had to pay $35 document fee for my Dr. to fill out my referral papers. I also had to pay $35 to get a copy of my medical records. However, all doctors are different and may not charge anything. My surgery date is Monday 03/24/03. So that's all the information I have at this time. Hope this helps. Good Luck and Best Wishes!
   — Steph P.

March 20, 2003
Unless BTC give you this agreement in writing I would not beleive it. It is very unusual, especially since they do not know exactly how BCBS will pay. The next issue is that BCBS will pay 80% of UCR (usual, customary and reasonable) charges. So if they bill $5000 and BCBS approves $4000 then they will pay 80% or $3200, leaving a balance of $1800. I've had BCBS for 15 years and know them very well. <p>Does BTC bill the entire surgery - facility charges, anesthesiologist, room charges, surgeon's charges etc? If not then I would interpret what they are telling you is that they will accept 80% payment on their bill. They can't speak for anyone else. I'm not familiar with how BTC's work. Again, I would not count on anything that is not put in writing.
   — zoedogcbr

March 20, 2003
I know that when I worked at an inpatient psychiatric hospital and patients had a copay, I was told that it is illegal to waive their copay. I don't know if this is true at all, or just here in MI, but like the [previous poster said, I'd get it in writing!!!!
   — [Deactivated Member]

March 20, 2003
Hi Krista! I am also going to BTC (Wylie, TX) for my surgery. When I made the appointment for my first consult I asked my representative how much out of pocket I should expect to pay. She told me that most patients that got to BTC, Wylie do not have to pay anything until after all the bills are submitted to your insurance. Once your insurance pays their share, they will contact you to let you know if you owe anything. She said in a lot of cases, patients only end up paying the $85 for the first consult. I was also told that after the surgery you will never have to pay another pennie to them for aftercare. It is covered for the rest of your life. If I were you I would call your rep at BTC and ask again exactly what you will be expected to pay. Ask what the worst case scenerio would be, if you have no complications. I have Pro-America, which is a PPO. My policy has a $400 deductible, max out of pocket expense $1000. Hope this helps some. Feel free to email me if you would like.
   — Maria S

March 20, 2003
I initially went to BTC in Langhorne, Pa. I also have a 80/20 for out of network. Which the BTC is. I was told since I was reimbursed by the insurance company, I had to pay the entire fee up front. They offered to help me get financing with a bank.I thought thanks but no thanks. I found a doctor in network.
   — Joann W.