Question:
You may be owing more than you think!

Cindy Rella Surgery: Hoping to have surgery PLEASE BEWARE!! I have insurance that has approved this surgery. They will pay 80/20 like many of yours. Sounds good? Well, what you may not know is that there is a little catch phrase called "usual and customary". This means that not only do you pay your deductible, but you will also pay the difference of anything and everything that your insurance company does not. For example...your deductible may be $2,000 per calendar year. You go in and have the surgery. You are seen by the Surgeon, Respitory therapists, to anasthesiologists, etc... So now it's time to bill the insurance company, and everybody submits their claims. Say the surgeon bills for $8,500, Respitory bills for $5,500, anasthesiologists for $4,000. Chances are, your insurance company WILL NOT pay the full balance or even 80%! They will pay what they feel is "usual and customary." So if insurance only gives $5,000 to the surgeon, guess who ends up paying the difference. YOU DO. And that goes for EVERYTHING, including your hospital stay! You can easily end up shelling out over $10,000 for this surgery and that's WITH insurance. Unfortunately, Patients usually find all this out, AFTER THE FACT. I went thru Surgilite. Guess what, they don't care about you! This is a business! You are a cash cow to them. The only thing they care about is lining their pockets. They will not put anything in writing that has to do with accepting ONLY what the insurance company pays after your deductible is met. I was told, however, "not to worry about it and to just come in and have the surgery". I said "not worry about it??? Well in a year, I may be thin, but I'll be homeless!" She then replied "I don't know what to tell ya then". Just know the money end of it BEFORE you get this done...ESPECIALLY if you're using Surgilite.    — Cindy R. (posted on December 14, 1999)


December 14, 1999
Many hospitals and doctors accept what the insurance company pays, and doesn't bill for anything further ... HOWEVER, I am finding out the same thing ... so far I owe the hospital almost $6000 I didn't know about!!!! I plan to fight it!
   — Sherrie G.

December 14, 1999
Most "traditional" type insurance companies have usual and customary, and depending on your area most insurance companies have surgeons and hospitals that fit in these "usual and customary" fees. I have Aetna, had my surgery October 14, 1999, and have received most of my bills and statements from the insurance company... they are paying what they said they were paying and more! I am only paying $55 for the $14,000 hospital bill... and about $400.00 by the time I am finished with the Doctors bill. You are correct however that people should be aware of what their insurance company will pay for. I found by getting the CPT codes from my dr. office I could call my insurance company and they could tell me if the dr's fee was in the usual and customary price range... I did this before my surgery... I was very pre-pared to go in debt for this surgery... thankfully I have a wonderful insurance company. My husband and I talked many hours of the amount of debt we may be taking on with this surgery, we accepted this probable debt and moved on. I would rather be worring over money then my health... in the long run. But this is just my opinion and I only speak for myself and my husband, we are all responsible for ourselves and with any major surgery there will be bills weather they are big or small and I think most of us realize this before we take the plung... and most of us have accepted that we will be in debt... but much healthier (just one persons opinion) :-)
   — Jamie T.

December 14, 1999
Cindy, Would you mind emailing me the name of the Hospital or Surgeon you were dealing with? I live in Santa Clara, CA and will be applying for approval the first of the year. I want to steer clear of situations like the one that you described. Thanks for your help.
   — JoAnn B.

June 3, 2000
If your surgeon and hospital are "participating providers" then they have agreed to accept a contract price (which is what the insurance company deems usual and customary) for the procedure. That means that the hospital / surgeon etc. CANNOT come back on you to collect the difference! You definately should fight it!!!!!!!!!! Good luck.
   — Rene` B.




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