$75,000 Bill! So Confused/scared..please Help!

[NewMissB 14]

Hi Everyone,

So I got a bill in the mail today from my surgeons office with two bills to the amount of $75,000, and I nearly passed out. My surgeon does bot participate in my insurance plan, but he accepts it. I was told that after I was approved (GHI/BCBS/Emblem Health) I would get checks in the mail from the insurance company and have to endorse them, and then send then to the surgeon. I received two checks, one for $303 and one for around $2,500. The surgeons office included a copy of my claim to the insurance company, which basically showed that's all that was covered. I don't know what to do and I'm panicking.

Can someone please help me understand if this is correct, or if my insurance just needs to send more checks? I'm freaking out and I was told I was approved, so this really scared me. Any advice you can offer is much appreciated, thank you!!!

-Britt

[1shauna1 129]

Sounds scary! I'm sorry I can't really offer help, as I was self pay and the total was $16,000 (seems so small compared!). Can you call your insurance company tomorrow and see if they can help? If they've said it was covered, then they should be covering this!

[marfar7 1,533]

That's an awfully expensive lapband you have there. Must be pure gold! My whole surgery (including a yrs worth of fills) was $15,000. And I think that's an average cost of lapband surgery.

I would call the billing dept and find out if that's what they're truly billing your insurance company and if it was a mistake.

Marci

[NewMissB 14]

They aren't open tomorrow or I'd be calling first thing!!

I had a hiatal hernia repaired as well as being charged for "laparoscopic enterolysis" which is removal of previous scar tissue. Both of those procedures were billed at $15,000 a piece, and the lap band was $40,000. This seems awfully expensive and I'm just so scared, cause I'm a college student on my parent's insurance and clearly do not have that kind of money!

Thanks for your advice tho!

[alabama86 2]

I hope you get everything worked out. If it wasn't for me still being on my parent's insurance I wouldn't have even gotten the surgery. They paid 90% I believe it was and I was left with a small 3000.00 out of pocket.

I really hope that it was a mistake, that letter, and that you get everything worked out because a bill should be the last thing that you have to worry about.

[AXA 19]

One time, I was charged $5,000 for a one hour emergency room visit with no tests or medicine. The reason I was charged so much was that my husband didn't have the wherewithal to give them my insurance card so they charged me as much as they could. It's a great way of making money. Once I got them my insurance card, suddenly the bill they charged insurance went down to $800 and I ended up paying nothing.

That is what is happening to you. Doctors can charge whatever they want. I also had a hernia fix and a lapband. The bill to insurance was only $14,000 and I paid around $2000. That is how much it costs. Depending on the state you live in, there are laws that say you don't have to pay more than what the doctors get from the insurance company. At most, you are out $15,000.

Talk to your insurance first. It may be a mistake. Then, talk to your doctor. His billing might be mistaken. If he stands by his costs then he is commiting fraud and you need to report him to the medical board.

[NWgirl 574]

my insurance was billed for about 20k and paid about 16k total due to contract pricing. Sounds like your Dr is scamming.

[SageTracey 608]

And without intending to sound harsh, in future, be sure to ask exactly how much you will have to pay so that you don't have to go through this stress again!

I hope you are able to come to a good resolution.

[neversatisfied 19]

Yeah, I had a hernia repair and band. They charged my insurance $49,000. I paid $5500 cash for the actual band. all you can do is call the insurance and ask what your final Co insurance responsibility is

[Joybgunter 19]

That is dreadful! And SO WRONG!!!!! I had a hernia repair w mine too and stayed a night in a big luxury hospital room and it was 12-14,000.00 w 6 mos. of fills. What did your Drs. Office quote u before your surgery? Also, while your waiting for offices to open, see if u can find ANYTHING in writing from insurance or Dr quoting price. Good

Luck to you. :):)

[honk 780]

Hi Everyone' date='

So I got a bill in the mail today from my surgeons office with two bills to the amount of 75,000, and I nearly passed out. My surgeon does bot participate in my insurance plan, but he accepts it. I was told that after I was approved (GHI/BCBS/Emblem Health) I would get checks in the mail from the insurance company and have to endorse them, and then send then to the surgeon. I received two checks, one for 303 and one for around 2,500. The surgeons office included a copy of my claim to the insurance company, which basically showed that's all that was covered. I don't know what to do and I'm panicking.

Can someone please help me understand if this is correct, or if my insurance just needs to send more checks? I'm freaking out and I was told I was approved, so this really scared me. Any advice you can offer is much appreciated, thank you!!!

-Britt[/quote']

Well, doctors usually charge X, and then there is the agreed apon price from the insurance. The original price is what they charge people without insurance. That higher price is probably what your bill reflects.

[NWgirl 574]

another thing is that your insurance may have required you go to a center of excellence and he may not be one. If that's the case, you would be liable for the bill. Did you contact insurance prior to the surgery to find their policy?

[muelle 64]

Here is what I learned, the hard way, many years ago about insurance. We had an insurance where none of our local doctors were included in the PPO. So our insurance paid X amount and we were responsible for the copay and the remaining amount. Not only did I learn this, but I also learned that doctor's offices charge different amounts depending on who your insurance company is, or if you have insurance. Most of the time people without insurance get charged quite a bit less than people with insurance. I didn't realize that I had to pay not only the copay, but the large amount that the insurance didn't pay, until I spent hours on the phone with the insurance company. Needless to say, I quickly switched to an insurance company that had my doctor covered in the PPO as soon as I could. So now that my docs are in my PPO, whatever amount is not approved by my insurance gets written off and I only pay my copay. So with my surgery, I paid a $35 copay for the consultation, and $20 copays for the 6 month pre-surgery nutrition appointments with my doctor (if I had gone to a nutritionist, my insurance would have paid 100% with no copay). The surgeon's bill for the surgery was about $15,000 and the hospitol bill for an overnight stay and all of the operating room stuff was around $35,000. My insurance covered the agreed upon amount, and I had to pay $0. I hope you don't get stuck with the remainder, but that was the case with me when my doctor wasn't in the PPO. I would think the surgeon's office should have told you it was going to be X amount of dollors for you before they did the surgery. Good luck to you!

[NWgirl 574]

Did you get the bill figured out?