Post Surgery Insurance Meltdown :'(
I had open RNY on May 2nd. Just found out TODAY that employer's BCBS policy has a $10K cap for gastric bypass. After MONTHS or research, many many phone calls, approval process, et. all - NOW they tell me they will only pay up to $10K. Leaving me with a whopping $12K out of pocket. This may bankrupt us. I feel like such an idiot. Employer insurance administrator, Dr's office and BCBS - NOBODY mentioned this important detail prior to surgery. Has anyone else ever experienced anything like this??? I am devistated - everything is going so well and I'm so happy with the results. I don't regret the surgery and I wouldn't give it back for ANYTHING, but if I had known - I would not have been able to afford it and couldn't have done it.
Marsha;
Most hospitals will make payment plans for you. Also, many will accept whatever your insurance pays as payment in full. For instance, my hospital bill was $19K. My insurance paid them $6K. I paid about $400 in co-pays and that was all they required.
Years ago, I had outpatient surgery on my wrist. It was the first Christmas my husband and I were married and we weren't wealthy by any means. When I received my bill from the hospital, it was nearly $800. $800 the week of Christmas, so I sent $300 with the expectation that I'd receive a second bill for the balance. I never heard another word. Apparently the $300 was more than they expected to get.
So, don't have a meltdown over this. It may be a lot less than you're expecting.
Blessings,
Jennifer
253 / 158 / 137
Then maybe it was meant to be that you didnt know about it.......hang in there, it will work out. I owe about $8,000 and I have no idea how I will pay for it. I have applied though for a financial plan that may reduce it throught the hospital. Call your hospital and see if they have anything to help you. Help may be out there.
I havent experienced this but I would talk to the hospital and see if you can pay the CONTRACTED rate and not the full bill. I had lap RNY last month and my hospital billed BCBS 22000$ but their contracted rate was only $11000 leaving me to pay my 10% which was around $1100. If they, along with the surgeon/anesthesiaologist will let you pay the remainder of the contracted rate then you are looking at a lot smaller amount of bills!
Don't panic yet! BCBS negotiates costs with both hospitals and Doctor's. Wait until you get your explaination of beneifts from BCBS. It will say:
1. What was paid by them
2. What the discounted price was
3. The remainder that you owe
It will be alot less then you think it will be
My hospital bill was over $30K but with the discounts it was brought down to over half.
So hang in there awhile. It may not be as bad as you think. And when all is said and done, both the hospital and the doctor's will work out a payment plan for you.
Good luck,\\
Ronna
Thanks ladies for your support. After a LONG day of phone calls to BCBS and my husband's employer... I'm hoping they will work something out. Sounds like his boss is intervening with BCBS on our behalf. The certificates of insurance (official books of their new policy) were NOT sent out on time and we did not HAVE it to refer to until AFTER my approval date of April 1. I HOPE they will get this all straight. I almost had breakdown! Makes me realize that this journy is still going on and I have to roll with the punches and just stay strong. Taking care of myself and making each day a good one. I'll let you know how it all turns out. Thanks again. M.
The others are right on. The way it should work is your doctor and hospital bill the insurance company and you for their "regular" rates and the insurance company will send you a statement showing what the hospital, for example, billed then what the contract amount is, how much they pay and how much you pay.
So it should be something like a total bill of $22,000, contracted amount $12,000 so you owe $2,000 if the cap is $10,000. Now if they do not do it this way you will have to fight for it but I think you would win.
Jim Randall
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