Question:
If my insurance covers 90 % and I cover 10%
I have BC/BS PPO. My plan covers 90% If the surgery costs $28,000.00, does that mean I owe $2,800.00 up front to the hospital before surgery? I'm confused and scared. HELP — Patty N. (posted on February 29, 2004)
February 28, 2004
I had Great West and had to pay a $100 deductible and they covered
everything else 100%. While the initial bill I got for the hospital,
including everything but surgeon's cost, was about $29,000, you usually
only pay 10% of the discounted rate for your insurance. For example, my
insurance ended up paying about $5800 total and the rest was discounted
off. The hospital actually had to refund me almost $400 because they made
me prepay $500. You probably want to double check with your insurance
company just to be sure, but it shouldn't be that much.
— Rachael B.
February 28, 2004
Check and see if your hospital stay is covered at 100% after you meet your
deductible. I paid my surgeon $1000 upfront and after the insurance paid
the with the discount. (He was on my PPO list) The surgeons office
refunded me $250.00. I did have to pay my percentage for labs and the
anestheisiologist (sp)
— babrewer
February 29, 2004
The surgeon I was going to have surgery with wanted his payment from me
before surgery. The hospital was willing to take payments. I would have
paid $1000.00 to the surgeon, and $2500.00 to the hospital. I ended up not
having surgery in the states cuz my insurance denied the whole
thing.....But call both the hospital and your surgeon to find out. Better
to know ahead so you can plan for the money, than to find out a few days
before and need to reschedule !!!! Good luck to you
— jennap
February 29, 2004
hi i have bc/bs as well and my plan saids 90/10 but after the deductables
and the hospital is a straight 100$ per visit.i have only payed about
300$.if you go to a perfered provider.the hospital takes concessions for
bc/bs so the amont you owe is a % of the cost they cover not the 28,000.$.
bc/bs total cost for my surgery was 8700.oo$ so my portion was from that
amount not what the hospital quotes you. email me if you have any questions
just be sure it is prefered provider. thanks
— patty L.
February 29, 2004
Hi. I also have BC/BS PPO. The hospital requested $22,410.50...the
insurance paid $4,943.19...I have to pay $231.81. The surgeon requested
$6,618.00 ...the insurance paid $1,500.57....I have to pay $355.73. I don't
know what they paid the anastesiologist yet but I'm paying much less than I
expected.
— AmyWollet
February 29, 2004
I used to work for Carefirst. You should only be paying 10% of the
"allowed benefit", not of the total being charged. If you are
going to a participating provider, they must accept the "allowed
benefit" as payment in full. Your surgeon's office should be able to
tell you what Blue Cross is paying for this surgery, they should not be
trying to collect any more than that allowed benefit, and it does not
matter what "their charge" is, Blue Cross determines what he is
allowed to collect.....if he is participating that is.
— Bozgirl271
February 29, 2004
Patty,
I have BCBS and my surgeon and hospital are providers so my bill was
32,000.00 and I only pay 1,100.00. And the hospital has put me on a
payment plan, plus I had my surgery 6 months ago and haven't had to make a
payment yet. Hope this helps.
— Dianne W.
February 29, 2004
You may also want to check with your insurance to see if you have an
out-of-pocket cap. I have BCBS PPO as well, and we have a $500 max
out-of-pocket. Which means that we only have to pay our co-pays till they
add up to $500, and the rest is paid 100% by BCBS.
It is worth checking into!
Our BCBS number is 1-800-258-8000 (that is for Michigan, I am not sure
whrere you are at.)
Good luck!
— Dawn R.
February 29, 2004
The 10% that you will owe is based on the contracted amount. For example,
your total hospital bill is $28,000. However, the BC/BS contracted amount
with the hospital is $3000.00. You will pay 10% of $3000.00 or $300. The
balance will be written off by the hospital and they cannot charge you for
this.
— Patty H.
February 29, 2004
What the hosital charges and 'what they get' are toooo different thingies'.
First ; check your hand book to see what your 'max' out of pocket is...
i.e. mine was $1000 that was the MAX I would pay. the 10% is based on what
they approve; example: mine was 9000 so my 10% was $900.
— star .
March 4, 2004
Hi Patty! Your insurance company should have a maximum out of pocket,
however, I have Humana. They have in network people and out of net work,
which means I pay 20%. Anyhow, they also have max out of pocket based on
your salary. They neglected to tell me that if the place you have it done
bills more than they plan to pay,you have to pay the difference. Check
every detail with them. I was supposed to pay $2250 and now I'm stuck with
a bill for $4000.
— Debbie W.
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