Question:
Anyone had out of network hospital and/or Dr and paid over reasonable & customary?

I want to hear about anyone who has had to go out of network and had to pay the amount above what your insurance called reasonable and customary. What amount was your surgery and what did you have to pay that was not covered by your insurance. Thanks!!    — Barbara S. (posted on March 27, 2003)

March 27, 2003
I really need to know this. I went yesterday to bariatric treatment center for pre-op testing and was made aware that I will be responsible for the amount abvove what is reasonable and customary.
   — william T.

March 27, 2003
I had to give my surgeon $3000 up front because he would not accept what Blue Cross paid. The hospital did accept it. They billed $22,000 and were paid $10,000. Someone earlier posted that BTC billed for $48000 and BC only paid 12,000.
   — sandy L.

March 27, 2003
Usual and Customary varies, so no set amount will give you the answer you want. The insurance companies set the U&C by what doctors in your area generally charge. This amount varies from city, state and county. Hope this helps. Robin
   — Robin J.

March 27, 2003
I live in NJ. Because my dr. was out-of-network I did have to pay him $3,000 up front. My hospital bill was payed in "full". The bill was $46,350, BC/BS PPO payed $6,280(amount allowed). We have a new law in NJ: even if you're admitted by an out-of-network dr., if the hospital is in-network, the ins. co. now has to pay the full amount allowed. I did have to "remind" the ins. co. of this. Initially they were telling me I owed $2,100. My balance is now ZERO!
   — j D.

March 27, 2003
I am in the same situation with Aetna and I have yet to get a reasonable answer from BTC. I have been told that their professional fees (surgeon, anesthesiologist) are in line with reasonable & cusomary (R&C) in my area, therefore I shouldn't have to pay for those. However, they won't/can't give an answer on hospital charges since those can vary depending on whether or not you have complications, extended stay, etc. I was told that it's possible that I could end up owing several thousand dollars above and beyond my $4000.00 out of network maximum for covered expenses. I was also told that BTC can offer financing - no interest and payments stretched out over (up to) 5 years. Good Luck
   — Carolyn M.