PPO Costs?

[lrmb]

Hi everyone,

Has anybody had experience of surgery with a PPO where you take a percentage of the costs yourself? I would like to try and figure out what, on average, the out-of-pocket expenses are like. (I know this will vary plan to plan, but a ballpark figure would be good to have in mind.)

Also, are there any "hidden" expenses that should be born in mind??

Thanks! Laura

[suejeryl]

hi, laura! check to see what your annual out-of-pocket expense limit is. our plan had a $2000/year/family member out of pocket expense limit. by the time i had surgery, i'd spent that $2000 out of pocket on 2 cortisone injections from a pain management specialist; an emg; and a contrast ctscan (in addition to regular medical expenses for 9 months of the year). as a result, my total out of pocket expenses for surgery,a week in intensive care, a week in rehab, and my follow up appointments through the end of the calendar year were $0.00. i participated in an fda test; i don't think the anesthesiologist billed the insurance company. there were probably some other "gimmes" associated with that test as well. i had some medication expenses when i went home, of course, but my dr. stuck to generics. we had to pay someone about $1,200 to watch the kids after school for 6 weeks. pt occurred in the new year, but i met my deductible quickly after which my pt was $320 out of pocket for 24 sessions. we were surprised (and enormously relieved!) at how little things cost. stay in the preferred provider network, of course! i hope this helps.

[lrmb]

thanks!

THANKS Sue. I am fortunate enough to have a choice of insurance plans, and the PPO offered seems to be similar to the one you were using. It is very encouraging to hear good experiences! I will spend some time figuring out the details of the plans, and I'll be sure to be careful about the provider lists.

Thanks again Take good care! Laura

[kathleensrose]

Laura surgery costs

Laura:
I can give you my example . Since I am a retired Texas teacher, my out-of-pocket expenses cap was $5000. We have spent about $1000 above that for those providers who were not on our PPO list. It is also important to find out the date end of your insurance company's cycle. Mine is the end of August so any expense incurred now till the end of August will be covered: for instance, a mamogram, or exrays, or other surgery will be covered. After Sept, the deductible and out of pocket start again. Kathleen

[lrmb]

thanks Kathleen!

Dear Kathleen, Thanks so much for your reply. I will definitely keep the insurance cycle (which I didn't know about) in mind. I want as few surprises along this road as I can manage! Thanks again. Take good care. Laura

[HGD24]

Hi Laura! Like Sue, I have a PPO and had a $1500 out of pocket deductible. My surgery and hospital stay total was over $100,000 and we've only been billed for services up to that $1500 limit. All other expenses have been covered! I also took a long, hard look at my insurance options before enrolling last Fall and it was definitely worth it!