Question:
Nevada Resident-If insurance denies me and I want self pay. I have figures and the
the amounts so far. My question is the amounts quoted aren't at a discount. How do I get them to drop the cost down like they do for the insurance companies? Is this too much to ask? To get a better deal just because the insurance doesn't want approve of surgery for me.Then I worry that after surgery I will have problems and can't afford the cost. Will my insurance step in and then take over because I developed problems after surgery? Does anyone know or been there? Barbara — Barbara T. (posted on March 18, 2003)
March 18, 2003
I don't know about negotiating a better price. I would suggest you check
with your insurer to see if they will cover any complications though. Mine
will not cover any health problems that can be traced back to a denied
procedure if the health problem occurs within one year of the denied
procedure. If it occurs after the 12 month period they won't even bother
to investigate how it occured and will pay for it as they would any other
health problem.
— [Deactivated Member]
March 18, 2003
Barbara, your question about what happens if self-pay patients develop
complications is the reason I probably will not have the surgery if my
insurance company doesn't cover it. Sure, I can get a home equity loan or
dip into my 401(k) to get $25,000 to pay for a "routine"
procedure. But just a few days longer in ICU, two more surgeries (for wound
infection, for example), some longer-term complications, diagnostic tests
and medications would wipe me out and I could STILL owe money.
I shall be very interested to see what responses you get. As for your
particular situation, contact your insurance company and get their policy
for treatment of complications from denied procedures in writing.
— Kasey
March 19, 2003
I've thought about this when folks discuss self-pay. I ended up in
intensive care for twelve days after surgery, into a rehab center for two
weeks, back into the hospital for twelve days (four in isolation) and two
more surgeries, more rehab center... Et cetera. Everything was paid for
at Medicare rates but the total is staggering! If I'd been self-pay I'd be
in debt for the rest of my life. I find it scary, but when insurance won't
pay what is the alternative? Nina in Maine.
— [Deactivated Member]
March 19, 2003
I have to echo what people have said about complications. I had my surgery
in May of 2002. I could not keep anything down from the very beginning. I
was in and out of the hospital and had too many ER visits to count. I had
a second surgery in July and was out of the hospital in August, then back
in a week later. About 3 weeks after that I went to a step down unit for 3
more weeks, then a skilled nursing facility for a month. I didn't get home
for good until October. At one point, before they had been billed for the
step down unit and the skilled nursing facility, my insurance had paid out
over $180,000 on my behalf. Like another poster said, if I had had to self
pay, I would have had to declare bankruptcy. I would have lost my house,
my car and probably all my other posessions. Most people don't go through
those kind of problems. I know that I expected to bounce back and be back
at work in 3 weeks or less, but it did not happen. Also, my brother and
sister went to bat for me with the insurance company to get me into the
step down unit when the insurance company decided I didn't need to be in
the hospital. My brother contacted the case manager at my insurance
company and told them I needed a place to go to so I could get back on my
feet. I'm not saying you shouldn't try to go the self-pay route, but you
do need to be aware that if you have any complications, you could be facing
some serious financial consequences.
— garw
March 19, 2003
I'm selfpay also. I'm having my surgeon consultation tomorrow and I'm going
to talk to her about her rate of complications, though there's never any
guarantees. I'm relatively low-risk since I'm a lightweight with no
comorbidities that could cause complications. My insurance explicitly
excludes complications, so I figure if I have any I'll have to try suing
the insurance. I wonder if this has happened to anybody, given how many of
us are self-pay.
— sjwilde
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