Question:
Am I getting ripped off?
United Healthcare insurance tells me that they will cover the surgery. Total cost of surgery is $21,500.00 but the weight loss consultant says that I will have to pay $8,500.00 out of pocket? yikes!!! does that sound right to you? Also I hear people tell me that it is so expensive probably cause it is not an in network surgeon. I don't know how to find a United Healthcare in network surgeon. I need to know how before I get ripped off! Someone Please Help! — T. B. (posted on July 2, 2003)
July 2, 2003
Call your insurance company number should be on your card or their address
you can write them. Ask them to supply you with a list of surgeons in your
area. Then call the surgeons and go from there Good Luck
— thesaurkratkid
July 2, 2003
sounds like they're right and it's an out of network surgeon. Does your
insurance have a website where you can look at surgeons who are "in
network"? You should be able to call and inquire or ask them where
you can obtain a list of in network physicians/surgeons.
— [Deactivated Member]
July 2, 2003
your doctors office is trying to collect for your percentage as well as
the difference between what he charges and what UHC pays wich he can do if
he is not contracted with UHC ....most policys have an out of pockett limit
mine for example is 3000 so that would be the most out of pock my pockett i
would have to pay in any given year...call UHC (wich i used to have) ask
them what your out of pockett is because regardless of wether he is in
network or out that out of pockett limit applies...
— bekka K.
July 2, 2003
Try looking up the American Sociciety of Bariatric Surgeons web site,
asbs.com, I think, and cross referencing their membership in your area
against your UHC plan surgeons.
— Wendy R.
July 2, 2003
Bekka is correct about most insurance plans having a maximum out-of-pocket
cost, but it works a little differently than described. The "maximum
out-of-pocket" is not a guarantee that you will not have to pay for
additional charges. What the clause does is provide that once COVERED
services have reached the maximum out-of-pocket limit, then the insurance
company will pay 100% of charges that would otherwise have been covered at
less than 100%. That clause will not help you if this is indeed the case
suggested by another poster that you are being charged your 20% plus the
difference between the surgeon's charge and the charge the insurance
company will pay for. If the surgeon does not have a contract with your
insurance company, then he is allowed to charge you this difference, but
the insurance company will not consider it in your "maximum
out-of-pocket" limit; they will consider only covered expenses. I
agree with the others that your best bet is to find an in-network surgeon
if at all possible.
— Vespa R.
July 2, 2003
I have UHC and had to pay nothing. They contracted with my surgeon for a
much smaller amount than the surgery costs and my eob says I am not
responsible for the balance. I got a good deal but they paid such a small
amt that i am nearly embarrassed to go around my doc.
— Delores S.
July 2, 2003
delores, your doctor is in network, which is why they were able to
negotiate a smaller payment. It's beneficial for him as well, since it
helps send more specific patients his way. If he weren't in network he
would have gotten a % of his usual charges and you'd have been stuck with
the rest. Aren't you lucky :>)
— [Deactivated Member]
July 2, 2003
RUTH YES YES YES
— Delores S.
July 4, 2003
I have uhc, and only had to pay 200 for deductable. The only way they can
charge you if he is out of network. There is a clause that states if they
charge you over what the contract ammount is, you are not responsible for
the difference. You can go to UHC.com, and find out if he is in netwrok.
Good luck!!
— mellyhudel
Click Here to Return