Question:
After having this surgery that is very expensive to have and your insurance covers it

At some point does your insurance stop paying? I have Independant Health    — Darlene C. (posted on November 27, 2002)

November 27, 2002
Are you talking about your lifetime benefit maximum? Every policy is different. My policy from United Healthcare PPO is 2 million dollars. I'm not anywhere near it glad to say!
   — MARSHA D.

November 27, 2002
This surgery is not that expensive that they would not cover it all. And remember an insurance co. pays the healthcare provider only approx 40% of their bill, they write the balance off if they participate with them. So that makes the bill cheaper yet for the insurance. I have unlimited lifetime max. I'm not sure I know what you mean about "at some point does your ins stop paying?" other than a lifetime benefit amt. My surgery was a disaster. I ended up with 7 surgeries within a year and a half. Could not eat or drink for a year and a half. Had to be on IV nutrition for a 13 mths. My nutrition alone cost 400,000 dollars and my med bills went over a million. The insurance pd about 45% of that, the rest was written off since the hosp & surgeon participated with my ins. I pd nothing but med copays and office visit copays. But I did have an HMO.
   — Karla K.

November 29, 2002
Each insurance company varies on what they will pay. You need to check your certificate of coverage. Mine pays 80/20, but I have a $2000.00 max out of pocket per year. This means I will only have to pay $2000.00 regardless of what the surgery and post-op charges are. Most major surgeries have a 90 day global period. All post-op visits (not lab or x-ray) 90 days after surgery are rolled into the surgery cost. You can't be billed separately for them. This is a HCFA rule. Your best bet would be to check with your insurance carrier.
   — Kim DeHart