Question:
Out Of Pocket Cost After BC/BS Has Paid Their Part?

I have BC/BS of NC PPO and I was just wandering an estimate out of pocket cost after the insurance has paid their part. I am just getting started and was wondering if I would be able to afford it. Also any information on the costs of plastic surgery would be appreciated.    — Lisa D. (posted on September 25, 2003)

September 25, 2003
Hi! I work at Hickory Surgical Clinic, I'm not sure if you have decided on a surgeon or not. I have BCBS PPO myself and it really depends on your policy. I have a $750 deductible and they pay at 80% of the allowed charges. Also check into what your out of pocket max is for your policy. All you need to do to find out is simply call BCBS and ask them if you have a deductible for surgical procedures and how much they pay after you've met your deductible. Let me know if I can help any more! Good luck!
   — Ashley S.

September 25, 2003
I don't have BC/BS, but most insurance policies are similar in that they have a maximum out of pocket limitation. What makes the difference is whether your surgeon and facility are "in network" or "out of network". If they are all "in network", then you out of pocket max would kick in and they have to write off the difference between their negotiated charges and whatever they billed. However, if they are out of network, you will be responsible for anything that the insurance doesn't pay. They don't have to write off anything. That's the situation I'm in. I chose a surgeon and facility that was out of network - I knew they were - and I'll be paying close to $10,000 out of pocket. That was my choice though because I felt they were the best in my area and they will put me on a payment plan.
   — Carolyn M.

September 25, 2003
I don't quite get it, but I got a notice from my insurance company Unicare HMO that the hospital submitted a bill for $24,890.90. Unicare paid $5500.00 and included this message "This is the amount in excess of the allowed expense for a participating provider. The member, therefore is not responsible for this amount. It is not your responsibility to pay $19,390.90" I had my surgery 5 months ago and have not heard from the hospital so I guess this is right. I know that many times hospitals only get a portion of what they bill and a lot of people don't check things out and just pay the balance even though they are not required to do that. I know this was true for many bills my mother incured before her death.After being billed I called and was told nothing was owed. It's very confusing to me.
   — Andrea K.

September 25, 2003
i had BC/BS PPO and i just had my RNY on 8/12 ....so far i paid the $2,500 deductible, and i just recieved a bill for $252 from the anesthiologist for my 20% i owe... and so far nothing yet from the hospital...the hospital and my surgeon were in my network and that is going to help save me money....the deductible the hardest part to come by ...the rest you can pay little by little...
   — E. V.

September 25, 2003
I have Anthem BC/BC, my total out of pocket for everything was my $250 co-payment for the hospital stay.
   — [Deactivated Member]

September 25, 2003
I have Bc/Bs Fed PPO. The hospital bill came to over $11,000 but all I had to pay was $100. Surgeon and asst. surgeon came to approx. $6,200, I will have to pay about $300 for them. I consider myself very lucky, others have had to pay for much more then I did.
   — TheresaC

September 25, 2003
I have BCBS United of WI through the state, as I am a state employee. Not one of the doctors or facilities I used had a contract with BCBS but all I ended up paying was $101 of my anesthesiology bill. I did have a deductible and co-pay but I do not associate those with the WLS as they are a requirement of the policy I have. My total charges were just over $26,000, so $101 was a real bargain.
   — zoedogcbr

September 25, 2003
My hospital bill was 34,000 for M-W(at noon!) surgeon bill was @13,000, anesthesiologist was @2000....out of pocket for me is 747 for the hospital stay, 131 for the anes. and ZIP, ZERO, ZILCH for the surgeon!
   — kathy B.