Out of Network/Co Insurance HELP????

[LoriAnn81 0]

Hello Everyone,

I am going for my lap band consult on thursday. I have 2 insurance. Empire Blue Cross PPO (Primary) and Pennsylvania Capital Blue Cross PPO (Secondary). .The surgeon that I really want to use is a participating provider for Empire Blue,however where he would do the lap band procedure where he could do it (The hospital that is) is considered out network and they said I would have co insurance and I have to pay 30% out of pocket

However with Capital Blue Cross which is secondary covers everything doctor is provider and is considered IN NETWORK for everything

I'm trying to find out if capital blue cross would covere the difference and the copays

Or is there a way I could just strictly use capital blue cross.

Really not sure what to do???

[mattie7632 24]

The hospital has to file both insurance policies for you, you don't have a choice which policy to file with, it doesn't work that way unfortunately.

The primary will pay it's 70% or whatever is covered leaving a patient balance. Then the claim will be submitted to your secondary insurance carrier who will come back and cover up to whatever percent they cover, normally. If the secondary covers both the hospital and doctor at 100% in network then you shouldn't have a patient balance. If the secondary covers at 90%, you could still have to pay that 10%. This is not a guarantee and it's in your best interest to call your 2nd insurance and ask if anything is excluded and what, if any, will be your share after both insurances have paid.

Hello Everyone,

I am going for my lap band consult on thursday. I have 2 insurance. Empire Blue Cross PPO (Primary) and Pennsylvania Capital Blue Cross PPO (Secondary). .The surgeon that I really want to use is a participating provider for Empire Blue,however where he would do the lap band procedure where he could do it (The hospital that is) is considered out network and they said I would have co insurance and I have to pay 30% out of pocket

However with Capital Blue Cross which is secondary covers everything doctor is provider and is considered IN NETWORK for everything

I'm trying to find out if capital blue cross would covere the difference and the copays

Or is there a way I could just strictly use capital blue cross.

Really not sure what to do???

[LoriAnn81 0]

Thank you. I will call capital blue cross tommrow and verify it with them. Thank you.. Thats what the doctors office told me they would pay 70% then I would have the patient balance of 30% or coinsurance.. Thats what I was trying to find out if they would cover the 30%...Yes they do cover hospital and doctor 100% in network

[mattie7632 24]

Well most of the bills I see like this would leave you with no out of pocket! The lab and anesthesiologist, radiology and hospital are all subject to getting bills. They are probably all in network, but if not you could get a surprise bill. But my bet is you are okay. Nationally almost all facilities are contracted with standard BCBS PPO. Empire is not the typical BCBS.

Thank you. I will call capital blue cross tommrow and verify it with them. Thank you.. Thats what the doctors office told me they would pay 70% then I would have the patient balance of 30% or coinsurance.. Thats what I was trying to find out if they would cover the 30%...Yes they do cover hospital and doctor 100% in network