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Thread: What were some of your surgical costs?

  1. #16
    Join Date
    Jan 2006
    Location
    near Philadelphia
    Posts
    1,260
    Thanks Karen for the link. But to clear one thing up -- I think I'm saying "Cap" and thinking maximum payment that I would have to make. For example: after I pay $8,000, Boachie's services are supposed to be covered 100 percent. But does that maximum payout pertain to all OTHER services relating to the surgery as well??

    I was hoping to get away with total costs under $20,000.....

  2. #17
    Join Date
    Apr 2006
    Posts
    227
    Quote Originally Posted by Karen Ocker
    The cap means all medical expenses which are covered. My company had a $1,000,000 cap.
    Things not covered:hosp phone bill, TV etc are NOT in the cap.
    My insurance also has a $1,000,000 cap. But if we're looking at 200-300,000 for one surgery - in a family of 5...I'm thinking this is not looking fantastic. Karen, thanks for sharing that your company has that cap as well. I'm looking at my age and that I have a lot more life in me (I hope as do my children and hubby.

    THis is a very interesting site...and sure got me thinking!
    Always Smilin'
    35 yrs
    1 surgery (1982)

  3. #18
    Join Date
    Mar 2005
    Location
    east coast
    Posts
    359
    Quote Originally Posted by Singer
    Thanks Karen for the link. But to clear one thing up -- I think I'm saying "Cap" and thinking maximum payment that I would have to make. For example: after I pay $8,000, Boachie's services are supposed to be covered 100 percent. But does that maximum payout pertain to all OTHER services relating to the surgery as well??

    I was hoping to get away with total costs under $20,000.....
    You are thinking the annual maximum out-of-pocket deductable. things that count and things that don't depend on your insurance carrier... so I'd fine tooth comb the full policy document to find out..

  4. #19
    Join Date
    Sep 2003
    Location
    NJ
    Posts
    1,291

    Medical Insurance

    Green M&M,
    You're right about checking the policy/benefit manual carefully. They will have all the definitions regarding deductibles, co-payments and maximums. I suggest doing all this before surgery; I certainly was in no condition for many weeks to think clearly. My dear husband occupied himself for many hours with this.

    Other resources are the employer benefits dept and, when denied large claims, insurance services which help appeal denials. Also, each state has an insurance dept to file complaints.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  5. #20
    Join Date
    Jul 2005
    Location
    California
    Posts
    269
    Shari, do you have an HMO as your primary insurance? If so do you know if your surgeon put in a request for prior authorization for the assisting surgeon for the anterior portion and the outcome of the request? I would talk to your surgeons office to see if a request was put in for the assisting surgeon and if none was put in why. HMO's do not like to pay unless things have been approved ahead of time. Also, they require you to use an "in network" physician or a physician who is contracted with their plan. If your surgeon decided to use someone who was outside of that network I would think that it would be their fault, but you would need to contact their office first. I work with a physician doing referrals and authorizations, so let me know if their is any way that I can help. You should not get stuck with the bill.
    Mandy

  6. #21
    Join Date
    Aug 2005
    Location
    Illinois
    Posts
    151
    Some of these bills can be overwelming. My insurance requires a (in network Plysician and hospital). My Dr. I had was in my network and the hospital I went to for surgery was in my network. I was lucky to find one in my network. If not in my network my ins. only pays 80%. My ins. is real good about paying but it takes a long time to get everything payed.
    I was probably 3 or more months getting all the bills and statements in.
    I had an insident with my bill. The blood work and all labs were sent off to another location and that place was not in my network. I did not have to pay this other laboratory, but it took a lot of phone calls and patience to get it payed.
    I had an incident where I got a statement from my ins. company that they had payed my Drs office for x-rays everything except 1 penny. Then I got a bill from my Drs. office for 1 penny. They actually spent 37 cents for a stamp to bill me for 1 penny. I took the bill in there and gave them the bill and a penny they looked at me like I was stupid. They could not believe the billing department had billed me for a penny. I took it to billing and they said it was a mistake. I told them that the Dr. would be able to charge a little less for his services if they were not spending money for stupid things like billing people for a penny. They did not find it very humorous. But I did not care I was put out by it.
    Good luck to all who have to deal with ins. companies.

  7. #22
    Join Date
    Dec 2005
    Location
    new jersey
    Posts
    850

    predetermination??

    did any one have this happen when your predetermination was sent in & no response from the ins co.?? This makes me very nervous but my Dr's billing person said it happens a lot that companies just don't get back to her & does'nt mean it has'nt been approved... I have Aetna PPO so she feels I'll be fine but the Hospital bills scare me too & hope all is covered, pretty much...Ly
    aug 1st surg.......ant/post T2-Sacrum

  8. #23
    Join Date
    Oct 2005
    Location
    Grand Rapids, MI
    Posts
    313

    Going to check on this with my HMO

    I have a HMO and am going to check TODAY with the surgeon about prior authorization; especially since he is using an assisting surgeon. No way I want to be stuck with a $30,000 bill for one they won't pay for afterwards. I'll cancel the surgery first if it can't be approved beforehand. My family can't pay their bills now because I can't work!

    Deb
    Age 47
    Posterior surgery 7/24/06
    65T/75L
    Last edited by Cakedec; 07-06-2006 at 08:54 AM.

  9. #24
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,795
    Quote Originally Posted by lelc2002@yahoo
    did any one have this happen when your predetermination was sent in & no response from the ins co.?? This makes me very nervous but my Dr's billing person said it happens a lot that companies just don't get back to her & does'nt mean it has'nt been approved... I have Aetna PPO so she feels I'll be fine but the Hospital bills scare me too & hope all is covered, pretty much...Ly
    aug 1st surg.......ant/post T2-Sacrum
    Hi Ly...

    You should look at your policy to see if you need preauthorization. If you do, you should get on the phone and be sure you get approval IN WRITING.

    Regards,
    Linda

  10. #25
    Join Date
    May 2005
    Location
    Wheeling, WV
    Posts
    1,105
    To All,

    I never brought this subject up because I thought it was a mistake I had made, being nervous before the surgery and pretty much insurance ignorant!!! But to complicate matters even worse for me, my husband's union switched insurance companies Jan. 1st, 06. Talk about the run around without the exercise!!!

    Shari

  11. #26
    Join Date
    Jul 2005
    Location
    California
    Posts
    269
    Ly, if they have not gotten back to your surgeons office it could also mean that your surgeons office is not hasstling them enough. I would get on the phone to both your surgeons office and to the insurance company and start trying to get things done. Remember that in the world of insurance and healthcare only the squeaky wheel gets the grease. I know it is sad to say, but there are so many people to take care of now days, that charts often just sit on desks. It is really sad. There is a lot that you can do for yourself even if you just call the insurance company and tell them that you are scheduled for surgery on such and such of a date and you want to check on the status of prior authorization.
    Mandy

  12. #27
    Join Date
    Aug 2005
    Location
    California
    Posts
    88
    As for my insurance I have united healthcare PPO. They cover 100% for all in network providers. My surgeon and the hospital where I have had my surgeries are not considered in network. My dr decided before he even started seeing me that he would right off anything that was not covered by my insurance. So my insurance pays 60% for out of network and he rights off the rest. As for my surgery last year I had met my out of pocket max of 1000.00 so they covered it at 100%. My bill totaled around 150,000 for 3 days in the hospital. Crazy!!!
    All I had to pay was my copay which in this case was 500.00. That was well worth it for me! Now this year I am facing surgery in Aug and I have not met my out of pocket max yet so they were wanting to pay at 60%. I called my insurance company and they said all i had to do was write a letter stating that my dr was performing the services and there was not anyone in my area within 75 miles that could perform this surgery. Now this is true in my case because everyone that I have had consults with in my city have said I needed to go to LA to see a doctor and that my case was to complex and they did not want to take me on as a patient. So this worked out very well for me. So now my insurance is going to pay at 100% to my dr and the hospital. I am so lucky to have good insurance. They will probably want to drop me from the policy after they see the next bill...LOL...
    Hope everything works out for everyone.
    Also there is always a way to work out arraingmets with the doctors or hospitals. In reality they cannot make you pay, but they can report it to your credit. But they will right off ALOT of money, you just have to try!! Trust me I have done it many times and gotten large bills written off..
    Sarah 25 yrs old- Married with three english bulldogs

    1995-Surgery for scoliosis fused T3-L3.
    2000-Surgery for Rod breaking, relaced rod and took out upper rods.
    March 2005-Surgery for removal of all rods.
    August 2005-Fusion of T10-T11 due to crack in fusion, Rods put back in.
    August 2006- Surgery for fusion from L4 to sacrum.

  13. #28
    Join Date
    Aug 2005
    Location
    Illinois
    Posts
    151
    slprncess, I have United Health care also. They paid 100% of all my Hospital and surgery costs. I don't know if your ins. is like this but mine does not cover any Drs. visits. I had to pay for all my office visits, but over all it wasn't much. Our policy has changed this year. Now the ins. pays 80% and we pay 20 for in network. I beleive it is 60% the ins. pays and we pay 40 for out of network. I am glad I had my surgeries before they changed the policy.
    Goo Luck.......Mattie

  14. #29
    Join Date
    Aug 2005
    Location
    California
    Posts
    88
    Mattie,

    Yes my insurance does cover office visits but i do have a copay of 25.00 for the first 12 office visits per year. Anything over 12 visits it goes up to 50.00 per visit. Sucks so i try to keep my dr visits down if i can. I have been very lucky to have good insurance and i am glad they did pay at 100%. I dont know what next year will be or even if my company will have this policy. I am scheduled to have my surgery in Aug so I know what my costs will be.
    Did your dr help you out with any of the costs of the office visits? That can be pricy! I know that when i had my last surgery i had a lapse in my coverage b/c my work termed my position b/c i couldnt come back right away and they couldnt grant be another leave of absence (already had one in March for surgery) so my insurance had a lapse. They did offer me to go on cobra insurance but it was way to expensive $500.00 per mth just for me! And i was going back to work at the 7 week mark, didnt make since so i just decided to pay my bills out of my pocket. but when i got a bill just for one xray it was 400.00 for one xray! I coulnt believe it. So does this mean you have to pay for all these things out of your pocket?

    Sarah
    Sarah 25 yrs old- Married with three english bulldogs

    1995-Surgery for scoliosis fused T3-L3.
    2000-Surgery for Rod breaking, relaced rod and took out upper rods.
    March 2005-Surgery for removal of all rods.
    August 2005-Fusion of T10-T11 due to crack in fusion, Rods put back in.
    August 2006- Surgery for fusion from L4 to sacrum.

  15. #30
    Join Date
    Apr 2006
    Posts
    20
    My daughter had surgery 3 months ago. We still haven't gotten all the bills. Our out of pocket expense was $1050.00, since the Dr. did not do the surgery at the hospital I work at. I changed my insurance to a PPO for the surgery and had to pay higher premiums as well as out of pocket expenses. I have the option to change it back next year, which I probably will do. I put the out of pocket in a spending account which worked out well for us.

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