Why can't I get a straight answer from anyone???

I am so mad..     ..right now I could spit nails...I called the ins. lady at the doctors office 3 times...All I want to know is What I need to pay after my ins. if any.  She says she doesn't know for sure...I called Medicare..That was worse yet...Why can't I get a straight answer from some one??? I have gotten a few answers from my OH friends. All answers were quite different...Some had Medicare that paid everything, others had to pay some money and others said their Medicare wouldn't pay at all......But I got more infro from them, then from the drs. office or Medicare...So I still don't know what is what....I just don't want any hidden fees or have the doctors office want alot of money up front that I don't have right now...I have had all tests needed pre op (blood, x-rays, ekg, release from PCP) even had the consult with the doctor who is doing the surgery.(signed release for him to do the surgery) .even the ins. lady. Medicare has paid, all costs to date..Everything....I am almost there for a date and I can't get a $$ dollar $$ amount, that I might owe, from the ins. lady. What is a (Girl, old girl ) to do???????? I am on S.S. Diability. I have posted before about this, but this is getting way out of hand...I am so not Happy...HELP????   

im sorry your going through it.to me it sounds like they are wanting to wait.if anything else comes up after you paid.then they may be something they want paid for,then your on your own.just take it one day at a time.or call them back and tell them to get a total ready and you will come by and pick it up.or they may be waiting in case something comes up or wrong.then if they dont paid.your on your own.

 

marylyn

Hi there,just relax. They are not going to give you an amount,this is because of variables in surgery.
It is all based on how smoothly things go,they don't know.
I hope you get to relax.
Take care!

i work with insurance and there is no way they can give you a definitive answer before the surgery.  there are always variables so no two surgery situations are exactly the same

if medicare is your primary they will pay their portion first, and then any balances should go to your secondary if you have one.  if your doc participates with medicare they cannot ask you for money upfront, and even if they dont, they can only balance bill you afterwards if they do not accept what medicare pays.  

i know you are stressed but the insurance world works in strange ways

i hope you can relax about this a bit, but thats how it works.

good luck, jacki

The insurance lady can't give you a $ amount because she doesn't know what the charges will be.  You probably have a deductible to meet then eligible charges are paid at a certain percentage.  You will have to read your policy or she should be able to give you the benefits but you won't have an exact amount. Plus, if you have a PPO policy and use PPO providers, they will have to write some of the charges off and then you will owe a percentage of whats left. I am guessing you have this kind of medical coverage but it may be different. Again, get your policy out and look at it. Be sure to check the "exclusions" section. As far as Medicare goes, if they are covering your expenses related to weight loss now, then they probably will cover the surgery. Call them and ask if they cover the specific kind of wls you are having.  If you don't know for sure that your regular medical ins covers the surgery, have the surgeon send the insurance company a letter of medical necessity and they will respond in writing to say if it is covered or not. Also, if you have regular insurance and Medicare, they will coordinate benefits. One will pay as primary and the other should pick up all or almost all of whatever is left (assuming they both cover the procedure). Depends on your situation in determining who is the primary and who is the secondary carrier.

Is your regular medical insurance thru a former employer or are you covered as a dependent on your spouses policy thru work?  Are you over or under age 65?  All these things make a difference in who will be the primary insurance carrier.

Who ever handles the insurance in the surgeons office should know a lot of this.

Good luck with this.  It can be very confusing to someone who doesn't know anything about insurance. 

Lots of different variables going on here. Is your OI primary? Secondary? or a third one? Sometimes your o/i will pay what medicare doesn't cover, and vice versa.  Is the doctor contracted? in network? what about the facility? the anesthesiologist? all that plays into it also. What your asking for is a hard question, your doctors office won't know, nor will your insurance unless they have all the facts and charges. Some charges may be covered by one and not the other or covered by both or not by either.

Just relax.......