do you pay cash for dr. boachie?

[Janet]

I was told by Dr. B's insurance person, Theresa, that he expects to receive 80% of his bill; i.e., the patient is expected to make up any shortfall of the 80% after insurance. Remember that insurance companies exist to make a profit, not to pay our medical bills. Typically their initial payment is really low, so you then have to appeal their decision, and if you make enough noise (including saying you will notify the state insurance commissioner), they may, eventually, come around and pay a much greater amount.

It is really difficult to make a decision as to choice of surgeons when you are not given sufficient information beforehand re finances; we spend many many hours doing due diligence as to selecting a surgeon whose skills you trust, but we don't have that choice re finances.

[theizzard]

so janet, did you have to pay him the difference or did you wear the insurance company down and get them to pay him more money. my insurance is only 70% for out of network benefits. i for one can't afford to sink into that kind of debt even if he is the best surgeon out there.

[debbei]

so janet, did you have to pay him the difference or did you wear the insurance company down and get them to pay him more money. my insurance is only 70% for out of network benefits. i for one can't afford to sink into that kind of debt even if he is the best surgeon out there.

You also have to consider that out of network is 70% of 'Reasonable and Customary' for the surgury. Unfortunately for us, 'Reasonable and Customary' charges can be MUCH less than the doctor's billed rate.

[txmarinemom]

You also have to consider that out of network is 70% of 'Reasonable and Customary' for the surgury. Unfortunately for us, 'Reasonable and Customary' charges can be MUCH less than the doctor's billed rate.

Which brings up another b**ch of mine for all the surgeries I've had (knees, ankle, scoli, too many others to list) ... Anesthesia is ALWAYS above "Reasonable and Customary".

Why don't insurance companies UP the R&C on this, or someone make anesthesiologists LOWER their charges? This is definitely an area where the the state(s) Insurance Commission should be involved.

They're the only ones guaranteed you'll owe (even if your insurance is paying at 100%!).

Regards,
Pam

[amber24]

I had my surgery done when I didn't have any health insurance! I was blessed with the help I received! I think my total was over $300,000 due to the fact I had to be readmitted two weeks after my surgery was completed.