Question:
I just received a bill from my surgeon. Cigna has not paid all the cost of surgery.
I have HMO coverage with Cigna and now I am getting billed by my surgeon for $750 for the cost of surgery. I was led to believe Cigna covered it 100% — suzcar51 (posted on November 26, 2003)
November 26, 2003
I didn't think ANY insurance would cover it 100%. I have not received my
actual bill from my surgeon yet but in my statement from the insurance it
said my portion is a little over $500. I'm thrilled that is all I will
have to pay for the surgeon. That does not include the amounts for the
hospital, anastesialagist(sp), lab work etc.
— tazfan
November 26, 2003
All insurances have a deductible so that is probably what yours is. that
is the way my insurance statements are too. It says covered 100% then
there is a little side not about deductibles. I have medicare as my
secondary but I have still had to pay 250. on my surgeons bill. Nothing on
the rest of it though.
— Delores S.
November 26, 2003
HMO's typically don't have deductibles - they have co-pays for office
visits. I have Aetna and they covered my RNY surgery - and my wife's 100%
- as well as the hospital stays. The only $ we had to put out for was the
psych consult, nutritional consult and a $10 co-pay for the surgeons...
<p>
To the original poster - I would call Cigna at the telephone number that is
listed on your insurance card and asked them about this bill that you
received from the surgeon. It could be some filing error on the part of
the surgeon...JR
— John Rushton
November 26, 2003
What I would suggest is that you contact your insurance company and ask
them if they show you having any responsibility or not. If your surgeon is
in network with Cigna they should have taken a write off. This is another
reason you are getting a bill. I work in surgeons office and I know
sometimes when posting checks, I forget to take the required write off.
But the best thing that you can do is call your insurance company and ask
them. Or if you have a benefit book at home, look for your surgical
benefits. You very well may have a deductible. There are insurance
companies out there that cover 100% of their allowed charges. Then then the
surgeon, if they are in network, has to write the remainder off. Good luck!
— Ashley S.
November 26, 2003
The surgeon can be "in network" and still not be contracted.
Thats what happened to me. My surgeon does other surgery but was not
"contracted" for bariatric surgery which is 85% of his practice.
Therefore, I was billed. He does contract with other ins. just not mine.
If he is "contracted' then yes, he does have to write it off but not
because he is "in network".
— Delores S.
November 26, 2003
I can't tell you what the deal is with Cigna, but my Oxford plan paid 100%
of my costs, except for my initial consult copay of $15, and my 6 month
follow-up copay. Funny thing though, it cost me several hundred dollars in
phone, tv and parking fees for my husband when he drove into Manhattan to
see me.
— Fixnmyself
November 26, 2003
Most likely this is a charge for the person that assisted your surgeon.
These people don't have to have a special certificate of "first
assist" to help the surgeon, but many insurance companies won't pay
for their time. A good friend of mine works in surgery and does act as a
first assitant to the surgeon. They don't want to have her take the 3-4
months off to get the certificate of first assist so they don't get paid by
the insurance carrier for her. The patient must pay that part out of
pocket.
My surgeon warned us about this practice at the presentation. They have one
guy that assists on lap procedures and they feel he has helped on so many
that he is much better skilled than the person that does have the
"first assist" certificate. I didn't run in to this problem
because I had an open RNY. I am double covered by insurance so mine was
completely covered.
— Kathy J.
November 26, 2003
Cigna was and is my insurance carrier through my husband's work. I only had
to to pay 35.40 of my consult fee. That was the 20% of the visit. My
surgery was 100% covered. But, my plan is Cigna Healthcare, not PPO or HMO.
Those are bad about denying certain charges. But, be grateful that most is
paid for by insurance. There are so many people out there, my best friend
included, that their insurance is denying the cost of surgery 100%. She is
having to go through a state sponsered program to pay for it, or it was
gonna be "CHARGE IT"!! I think all insurance should be required
to pay for this just like all the other "disabilities" it pays
for!!! SAY AMEN!!! Obesity is the last "safe" thing to
discriminate against. This is very sad for our country. Thank you for
letting me vent. I feel a little better now!!
— VERONICA B.
November 26, 2003
If your surgeon is in network you are not responsible for any additional
charges. Insurance never pays the whole amount a doctor would bill a
patient. It appears your doctor is trying to make up the difference. With
an HMO you only pay you co-pay, unless there is some special "program
fee" that you were made aware of prior to surgery. Happy
Thanksgiving! Lynda ME/FL
— [Deactivated Member]
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