Whose insurance covered their surgery & sends you the checks to give to the surgeon?

[JoeyZLoisL 0]

How much did your surgeon charge & how much did your insurance cover?

I have BlueCross/BlueShield & the surgeon I had my surgery through is out of network. So the surgeon bills my insurance and whatever the insurance approves, they send a check to me, in my name to give to the surgeon. I had a first evaluation through the surgeon, then a gall bladder removal then the Lap-Band.

My surgeon billed for $75,890.00 for the operating room, recovery room, anesthesia, sterile supplies & drugs it says. My insurance approved it ALL. So they sent me a check for $75,890.00 in MY name.

A girl I spoke to in the billing dept. at the Dr's office said it wouldn't have been that much if I was paying cash for the procedure. This just seems crazy! I wish I was getting some of that money!!!

[Whillow 0]

I have no idea, I have harvard pilgram and they paid 100% of my surgery - the only our of pocket i had was 500 for the education class i had to take and copays at 10 bucks.. and even then the first 3 months the fill and follow up visits had no copay just had the first one yesterday.

[Humming Bird 275]

How much did your surgeon charge & how much did your insurance cover?

I have BlueCross/BlueShield & the surgeon I had my surgery through is out of network. So the surgeon bills my insurance and whatever the insurance approves, they send a check to me, in my name to give to the surgeon. I had a first evaluation through the surgeon, then a gall bladder removal then the Lap-Band®.

My surgeon billed for $75,890.00 for the operating room, recovery room, anesthesia, sterile supplies & drugs it says. My insurance approved it ALL. So they sent me a check for $75,890.00 in MY name.

A girl I spoke to in the billing dept. at the Dr's office said it wouldn't have been that much if I was paying cash for the procedure. This just seems crazy! I wish I was getting some of that money!!!

This really sounds like fraud on the part of the surgeon or the hospital and stupidity or something on the part of the insurance company. No wonder health insurance costs are so high.

My surgery (lapband + hiatial hernia repair), anesth., consult, follow up, fills for 3 months, NUT, ........ all came to $9,995. (self-pay) Why in the world would yours be over $75,000 ?! fraud

[JoeyZLoisL 0]

This really sounds like fraud on the part of the surgeon or the hospital and stupidity or something on the part of the insurance company. No wonder health insurance costs are so high.

My surgery (LAP-BAND® + hiatial hernia repair), anesth., consult, follow up, fills for 3 months, NUT, ........ all came to $9,995. (self-pay) Why in the world would yours be over $75,000 ?! fraud

Yeah, it seems really fishy. I feel like I should be able to pay them the cash price & have some money to spend on new clothes LOL.

But you're right....I understand now why insurance premiums are high - dooctors & hospitals are making a KILLING!!!

[emjay 8]

It sounds to me like your insurance company made a mistake. I would hate for you to be caught in the middle since the check is made in your name, but if they decide to try and get some money returned, you've already sent the money to the providers. Check with Anthem to make sure it was processed correctly. I can hardly believe they would pay $75,000 for what you had done, especially out of network. Normally what is paid is what is considered "usual and customary", not just whatever the provider pays. That being said and knowing that in different regions the cost of the surgery, etc. is much different, it shouldn't be that different. My surgery was close to $16,000 for everything plus 2 years of free fills, checkups, free physician fees if I need a port revision or have complications. If it cost that much in California, I would think alot of self-payers would be coming this way to get surgery done. And, if it cost much less if your self-pay, then something does not sound right and your insurance did not take into account what is considered UCR in your area. This may be found on a routine audit they do or from another company that specializes in finding billing errors. Better be safe than sorry!

[ElfiePoo 109]

I'd hang on to that check and call your insurance company pronto. If that's what they said they were billed, I would then call your surgeon's office. That's outrageous. I've never heard of this surgery costing more than $20K. Makes you wonder if your surgeon didnt pad the bill by saying he did a hernia repair or some other needed 'extra'.

When I use an out of network doctor, BC/BS of Michigan sends me the check. If I use an in network doctor, it sends it to them but I get a printout of what was billed.

.

[BetsyB 9]

It sounds like the insurance company made an error--and I'd draw it to their attention. If you signed the check over to the surgeon, then there will be no problem--the insurer will then negotiate directly with the doctor.

Aside from the fact that the bill seems very high, it seems odd to me that the surgeon's bill included all of the hospital stuff (OR, meds, etc.)

It's also unusual that an out-of-network would be paid at 100%---though if availability in-network is limited, they sometimes do decide to pay.

Give your insurer a call.

(Just a note: doctors often do negotiate smaller fees for self-pay. It's not a scam; it's intended to help those who do not have medical insurance afford care.)

[1unknownperson 0]

How much did your surgeon charge & how much did your insurance cover?

My surgeon billed for $75,890.00 for the operating room, recovery room, anesthesia, sterile supplies & drugs it says. My insurance approved it ALL. So they sent me a check for $75,890.00 in MY name.

This is a very common practice. The Hospitals, labs and Dr.s always charge more if insurance is paying the bill.... My Boyfriend lost his insurance for a few months when he was out of work and was due for his PSA Lab work for his prostate so he called asked how much it would cost and they told him if he had insurance it would cost $134.00 but if he was paying for it himself it was $25.00... All for one little blood test....

I have heard that the standard cost of lap-band paid by insurance is upwards of $75,000.... This is what really pisses me off... If they charged the insurance company the same as a cash/self paying patient, then maybe more insurance companies would allow it as preventative health measures... It's no wonder so many won't cover it at such an outrageous cost forcing people like me to take out a 6 year loan with Payments Higher than a new car!

The surgery was $16,000 plus 13.999% interest on the Care Credit credit, Card and when all is said and done, I'll be paying $22,320 for my lapband!!! Considering I had roughly 75 pounds to lose, thats almost $298.00 per pound!

The same goes for anytime the government is paying the bill as well... if you have section 8 (Low income Government subsidized house), the home owner will turn an $900.00 per month rental into $1,800 dollars per month where you pay about $500.00 dollars and the government pays the balance...

Or Government subsidized Child Care... My Daughter is a single Mom with two children so the government pays her childcare while she works... They pay the daycare school, $9.00 Per hour per child for a 10 hour day (They include the time you need to commute after you drop the kids off or after work to come back) But for the two days a week I have them (on my days off from my real job), they will only pay a max of $4.00 per hour each for family to care for the children..... Thank God she found a new school that is open 7 days a week so I can have my weekends back. I love my Grandsons, but I have raised my kids and I need time off to do my own stuff....

It's not a pretty picture! Big business has learned how to cheat the system... And I can see the pros and cons in some of the thinking. I understand that Day care schools have overhead and insurance costs and people who rent out homes need to have a cusion to cover damages done by the renters.... But geezzzz.... Dr's charging the insurance companies 3 or 4 times higher? Whats up with that?

[Cocoabean 430]

How much did your surgeon charge & how much did your insurance cover?

I have BlueCross/BlueShield & the surgeon I had my surgery through is out of network. So the surgeon bills my insurance and whatever the insurance approves, they send a check to me, in my name to give to the surgeon. I had a first evaluation through the surgeon, then a gall bladder removal then the Lap-Band®®.

My surgeon billed for $75,890.00 for the operating room, recovery room, anesthesia, sterile supplies & drugs it says. My insurance approved it ALL. So they sent me a check for $75,890.00 in MY name.

A girl I spoke to in the billing dept. at the Dr's office said it wouldn't have been that much if I was paying cash for the procedure. This just seems crazy! I wish I was getting some of that money!!!:ohmy:

I know it would be fraud, but my mind would be saying, what would be wrong with me cashing the check then telling the surgeon I will take the cash price please! :thumbup:

Then I guess I'd have to find a country with no extradition and live on the proceeds!

I got a copy of my bill. It was $42,000 or $45,000. Not sure if that included everything like anethesia or the OR. Sometimes they are billed separately.

My appendectomy with 3 days in the hopsital out of network (since I was on vacation, of course!) was $11,000. For the band, I was in and out the same day. Go figure!

[BetsyB 9]

I have heard that the standard cost of lap-band® paid by insurance is upwards of $75,000..

Mine was billed just shy of $23k, including an overnight stay at a bariatric center of excellence.