EOB (Explanation of Benefits)

[bbest]

I got an EOB in the mail from my insurance company the other day. It was for charges related to my surgery which my carrier did not originally pay and finally cut a check for. I put it in my surgery file with all the other EOB's and thought I would add up all the charges to see just how much surgery cost. I tallied up all costs actually paid by insurance - anesthesia, surgeon's fees (for 3 different surgeons), room and board, CT scan, x-rays, hardware... It amounted to over $110,000!! :eek: Patient responsibility $0.00. I will never complain about not getting my premium's worth again. I have cost them hundreds of thousands of dollars this year alone with several X-rays, 2 MRI's, 2 CT scans, 3 spinal injections, countless ortho visits, neuro visits, pain management visits, and surgery. Thank God for my HMO!

[LindaRacine]

Hi Brandi...

That's actually a pretty good value. Glad you didn't have to pay anything. My surgeries from 1993 were more, and I often hear of patients breaking the $500,000 barrier these days.

Regards,
Linda

[bbest]

I should calculate the actual charges since insurance only pays what they consider allowable charges.

[makaylasmom]

Brandi- that is awesome!!! My totals so far have come up to over $350K. So far- I have had to pay nothing (PPO). I'm still waiting on the one surgeons bill... so my total will go up even more...

[Cakedec]

My HMO paid 86,000 so far for their allowed fees for my posterior surgery (2 surgeons also). We are responsible for $250.00 for each hospitalization, still not much at all compared to 90/10 policies where we would pay $8600. (Not a possibility on our income).

I know a lot of negatives have been said about HMO's, but that is the only thing that has kept our family out of bankruptcy because of major health conditions. My college age son had to have two gastrointestinal surgeries last year and one this year along with my scoliosis surgery and my husband's foot surgery. My daughter has to take growth hormone injections ($25,000+ per year) and my husband takes Enbrel injections for severe psoriasis (also expensive). For both these injections we only pay $80/month co-pays.

If not for HMO's, our family would have had to move to Canada for their socialized health care.

Deb

[Shari]

Hi Brandi,

That's just wonderful!!! I've learned that insurance can be very tricky. That is just one bourdon you don't have to carry.

And from reading some of your other post's you seem to be doing great!!! :)

Shari

[lnetzer]

Wow, that is great that they paid your bill! I will never complain again about how much we pay for insurance every week! I just rec'd word yesterday from our insurance company that they'd cut a check for the entire $86,000+ hospital bill for my son's surgery. I was so relieved I cried! I just shudder to think of all the past EOB's that I just blindly accepted as correct, I've had to call on 9 different ones since January to get them corrected/adjusted to the correct percentage. I'm waiting to hear how much of the surgeon's bill they paid, that alone was over $25,000, with all the other health issues he had this year leading up to the surgery we are in excess of $150,000. Yikes! Just check those bills/explanation of benefits everyone!! :)