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Thread: Ten percent?

  1. #1
    Join Date
    May 2009
    Posts
    3,598

    Ten percent?

    Ten percent?
    i had a procedure Nov 18th in hospital...
    long story short, i am now billed about 10% of total cost
    Medicare, which i didnt want but had to take, paid most of the bill..
    my crappy Aetna policy, which costs me $435 a person a month for HMO, covered
    almsot zero....
    my question....should i expect a 10% bill for scoli surgery if/when i do it....?
    10% of $300,000, or whatever it costs, is a LOT of money!!

    i am gonna try to change out of Aetna next year...i can't have a Medicare
    advantage plan til i'm 65 they tell me.....

    Romney was right....we SHOULD be able to FIRE our insurance companies!!!

    jess

  2. #2
    Join Date
    Mar 2011
    Location
    Philadelphia
    Posts
    75

    Lonner and Insurance

    Hi Jess,
    Before you make a change in your insurance you should talk to Lonner's office as I believe you said if you had surgery it would be with him. I am not quite ready to have surgery, but I met with his office manager after my last appointment and they told me how much I would have to pay, which with my current insurance (which I won't be able to keep long) was only $1000. I believe Lonner takes Aetna. I also met with Errico and though he was in my network I would have needed to check myself with each of the people he brings in--the plastic surgeon for the scar, the person monitoring neurological condition and the anesthiologist so each doctor is different according to your insurance.
    Lisa
    60 degree thorocolumbar curve beginning at T12
    58 years old

  3. #3
    Join Date
    Mar 2010
    Posts
    2,646
    Hi, Jess.
    With a secondary insurance you shouldn't have to pay anything. They are supposed to pick up what medicare doesn't. I would call your Aetna insurance company and let them know. I've had to fight with insurance companies before and almost always won when it came to billing. It's my understanding that Medicare covers 80% of "allowed" charges, but Medicare providers have to accept the payment, even though it is usually WAY below the actual fee. Your secondary insurance is for the purpose of covering the rest. Is there an out of pocket maximum for the year? My insurance kicks in at 100% after I have paid $1,000 out-of-pocket in co-pay amounts. Sadly, I just made the $1,000 at the very end of December and have to start over. Now they have added a $500 deductible, which I don't know if it goes toward the out-of-pocket expenses. You have to read the fine print in your policy. It might not hurt to read it before calling so you are armed beforehand. Sorry this happened to you. I would definitely NOT pay it until you find out for sure, otherwise they'll keep doing it.

  4. #4
    Join Date
    May 2009
    Posts
    3,598
    thanks guys...
    good to know about Lonner...yes, he would be my guy...like him the most...

    rohr...i called Aetna...they said Medicare "overpaid" for some things, and the
    others Aetna "doesn't cover"

    jess

  5. #5
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,231
    Time to get out the insurance policy and read
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  6. #6
    Join Date
    May 2009
    Posts
    3,598
    Aetna is ridiculous...
    the procedure was done in the hospital...it was in November, so the deductibles
    were paid by then.....
    for an HMO to cost me $435 per person per month because i am
    retired is outrageous...esepcially when Aetna paid only $31 of my total bill, which was over $5500!

    anyway, my concern is really what would happen with scoli surgery...
    the procedure i had in November was nothing compared to what
    that would cost, so i am glad Lonner's office is used to Aetna nonsense...

    i do not see any politician who will end the insurance abuse of patients....
    as long as the CEO's make millions in salary and "bonuses" every year, it will continue...

    jess

  7. #7
    Join Date
    Mar 2008
    Location
    New Bern, NC
    Posts
    1,435
    Jess,
    I just fired my BC/BS insurance because they paid so little and charged way too much. If you only have medicare and no other insurance, the 10% that you would have to pay is only 10% of what medicare allows which is way lower than what the Doctor's charge or what the hospital charges. For instance, Dr. Rand's bill was around $50,000 of which Medicare paid $15,000, so I had to pay $1,500. I never saw my hospital bill since I did have a Medicare advantage plan which covered what Medicare didn't. Most supplement insurance policies have an out of pocket maximum which usually means with a big surgery such as scoliosis, you pay that amount before the insurance kicks in.
    We just purchased a new Medicare Advantage Plan which was much cheaper than BC/BS, but it has a $5,000 out of pocket maximum. We plan on banking what we are saving on the monthly premiums to self insure ourselves should we need to spend time in a hospital. We are hoping we can save the $5,000 before that happens.

    If your surgery costs $300,000, Medicare would probably pay (I'm guessing) no more than $90,000, so 10% of 90K would be $9,000. A lot of money, but doable if you don't have any other insurance.

    I hope this helps a little. Good luck!
    Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  8. #8
    Join Date
    May 2009
    Posts
    3,598
    thanks, Sally
    sending you a PM...

    hope you are safe from the crazy weather they showed on the news again
    in NC...tornadoes...scary...

    jess

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