Question:
If I am having my surgery at OSU and My Insurance pays 80% .
Does anyone have any Idea what I am looking at in cost for my 20%. — daddy43302 (posted on September 25, 2003)
September 25, 2003
It will depend on the rate reduction your insurance company has worked out
when they signed up OSU to be a contracted provider. For example, my bill
at Sacred Heart (same general part of the country) was $25,000. My
insurance had contracted a certain amount so that there was a write off of
around $6,000. They paid my percentages off of the reduced amount not the
charges. The best way to figure how much everything will cost is to look
at your "out of pocket maximum" for your plan, and figure it
can't cost you more than that. In my case, after the $6,000 was written
off, they paid part at the 80%, but then my stoploss kicked in and they
paid the rest at 100%. There were other providers (anesthesia, radiology,
surgeon) who were paid at 20%, but all totaled, my out of pocket max is
just that - my max cost. The only thing not included might be noncovered
services that you chose to have anyway, like a nutritionist not on your
insurance plan or something like that, and if you have a flat co-pay (like
$20 a visit, not subject to deductible), and your deductible is usually on
top of your OOP max, not included.
— bethybb
September 25, 2003
OOPS - I said the rest were paid at 20% - I meant at 80% and I am paying
them the 20%.
— bethybb
September 25, 2003
It depends on the region and hospital. I had a gastric bypass with 2 days
stay at the hospital and my bill was $41,000. I would suggest you talk it
over with the hospital and insurance to make sure you know what you are
getting into. Best wishes to you on this new journey.
— Marcy Z.
September 25, 2003
I just got out of OSU for open RNY. I'm sure there is a difference in
price but I will tell you what the hospital has billed my insurance for so
far. I went in on a monday and went home on Friday. Hope it helps.
Dr. Cook 6,070.00
OSU Hospital 21,884.90
Anesthesia 4,004.00
Misc Hospital charges 243.00
— Trin2rilax Cheryl McCoy
September 25, 2003
First, I don't want to assume which OSU you are refering to. Ohio,
Oklahoma, or Oregon?
If you are in Ohio, I found the cash prices that OSU quoted were about
$25k. The cash price at Mt. Carmel West is $13k. BTC does do cash, so I
can quote pricing there.
If I was going to pay 20%, I'd rather pay 20% of lessor amount.
For more info, take a look at: http://www.midohiosurgical.com
bob
— rleffler
September 25, 2003
Sounds like OSU is an "in network" provider since your insurance
is paying 80%. In that case, insurance should pay 80% of negotiated charge
and you will be responsible for 20% of the negotiated charge up to your out
of pocket maximum for "in network" coverage. Once you hit the
out of pocket maximum, your insurance should pick up the balance of
negotiated charges at 100% and the hospital will write off the difference
between negotiated charges and what was billed.
— Carolyn M.
September 25, 2003
Your costs will depend on what your insurance plan's contracted amount is
with that provider (asumming that it's an HMO, POS or PPO plan). For
example, your hospital bill could be $25,000. However, the contracted
amount with the hospital is only $3000. This means the insurance company
would pay 80% of the $3000 and you would pay 20% of the $3000 or $600 to
the hospital. The balance of the bill is a hospital write-off that they
can't charge to you. The same would apply to your doctor and any other
providers. Check your company's schedule of benefits for the maximum out
of pocket expenses (that $600 above would be considered part of your out of
pocket expenses) and that's the most that you would have to pay in a year.
Typically, most plans have a $2000 or $2500 out of pocket expense for in
network services (using the doctors and hospitals in your insurance
companies plan) in a year but the company you work for makes that decision
as well as what plan of benefits you have.
If you have a traditional plan (no HMO, POS or PPO), the insurance would
pay up to the reasonable and customary amount. However, once you have met
your out of pocket limit (check your company benefits) the insurance would
pay 100% for the remainder of the year.
Very few people have traditional plans anymore as they are not cost
effective. So my guess is you have an HMO, POS or PPO plan.
— Patty H.
September 26, 2003
You need to find out if your hosptial, surgeon, etc are in or out of
network. If they are in-network you will pay 20% of the price already
agreed upon by the provider & insurance. However if they are out-of
network the provider can charge well above what is reasonable &
customary (usually the agreed price for in-network). If the insurance is
charged more than reasonable & customary by an out of network, you will
be responsible for your 20% plus the amount that is not considered
reasonable & customary. Ex. the agreed price is $15000 (reasonable
& customary) in network you'd pay 20%=$3000, lets say out of network
may charge $25000 the insurance will still only pay $15000 so you'd have to
pay $10000. What exact cost is I'm not sure but 1st thing you'd want to ask
is if they are in or out of network, it will make a big difference in
price. Hope this helps.
— vllgmz4
September 26, 2003
Thanks for everyones input. Yes it is Ohio State. It is great my Insurance
covers WLS however, Out Of Pocket maximum does not apply to this procedure.
So I am stuck with the 20%. I don't want to sound like I am complaining
because I know there are people out there that would love to have 80% paid.
— daddy43302
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