Insurance costs more than cash?

[DallMike 0]

Ok, I'm looking at hospital and anesthesia bills of $13,000 that does NOT include the surgeon's fees. This $13,000 is my share AFTER insurance.

On the docs website the cash pay price that covers everything is...wait for it... $12,200. I am practicing great self-control with my grammar so I do not get banned from VSG Talk. Lots of 4 letter words with a couple of 13 letter adjectives.

Everybody was in network, deductibles and co-insurance met. I will be making some phone calls over the next few days. My 6 week follow-up is next week so I may have lots to talk about.

[lunarose 97]

Wow! I'd have more then my share of four letter words if it were me. I am self paying here in California 15,700 the anesthesia bill is only 1,000.

Nancy

[DallMike 0]

Yeah, I've been on slow burn for a few weeks. I'm just letting all the bills process and see what gets paid and what shows up in my mailbox.

I forgot to mention...insurance is Aetna PPO and benefits are 50% coverage. Really wondering why bother with insurance.

[mila1013 0]

Welcome to hell, ahhhh insurance bs is always great. first I don't know your specifics, longer surgery, complications etc? first ask your hospital for an itemized receipt. then get the EOB that state the amount that is billed, then the amount the insurance co allows and their payment. If you followed all the rules, in network etc. then they can not charge you amount billed and must accept the usual and customary rates. for example

amount billed 4,000

amount allowed 2,000

our payment 1,700

while the hospital can bill 4,000 you are responsible for the 300 only. umm btw insurance co and hospitals make mistakes all the time. Ask for all itemized receipts and request via your insurance co your EOB and you could also ask for the anesthesia, hospital bills that you have it you paid in full what kind of discount you get, that is common also. Now if you violated your subscriber agreement for any reason, this will not apply. hope all goes well.

[DallMike 0]

Everything was handled by the docs office and Aetna approved upfront. Everyone is in network and hospital is a center of excellence. All should be well.

I'm hoping that it is paperwork and coding issues since AETNA has only been covering sleeves for a couple of months. Maybe the anger and stress will help my weight loss?

[MINI-Me 196]

What is your out of pocket maximum for your policy? Normally even high plans are $5-10K. Definitely do not pay a dime of the costs until you have itemized bills and verify they match with the EOB's received from Aetna. Something does not sound right.

[DougNichols 124]

Nick Nicholson I assume? From people that have used him before, and had Aetna - what was your total out of pocket cost?

[FitatFifty 11]

You can also contact your state insurance commissioner's office for assitance if you still have difficulties with your provider.

Good luck!

[DallMike 0]

Still going round and round re: final bills. No help from anyone. Aetna, Dr. Nicholson's office, Baylor Regional Medical Center Plano. I have emailed a local Dallas television station and filled complaints with BBB. I don't expect anything other than you got it, you pay it. This is so wrong that insurance co-pays are more than cash price. Buyer beware. Do not accept any verbal reassurances that your insurance covers everything and not to worry. WORRY! I am smarter than that, but I guess in the weakness and fear of a life changing procedure I didn't practice my normal due diligence.

If it involves money, talk directly with your insurance company only they have the right answer. Do not believe anything from doctor or hospital insurance coordinators! Their job is to sell you a new car, i.e., get your signature.

[6kiddos 18]

Wow. I just checked my EOB's from my surgery. They added up to about $8k for what Aetna allowed. I am fortunate that I hit my deductible in June and this was 100% covered (wasn't sure about anest. but they did them too). I am sorry you are having to fight this! Aetna pulled one over on me for my physical therapy for my plantar fasciitis and only covered $25/appt. got hit with a bill for that.

[Miranda48 0]

If it involves money, talk directly with your insurance company only they have the right answer. Do not believe anything from doctor or hospital insurance coordinators! Their job is to sell you a new car, i.e., get your signature.

Yeah I'd totally agree with this sentence! It pays to shop around and find a few quotes from different companies to make the best informed decision possible. I'd check out http://www.medicalinsurance.org for more info, it's a good site. Hope that helps and good luck with everything!!

[DougNichols 124]

What Aetna plan do you have? What's the formal name on their site of it?

You should have an out of pocket maximum for the year.

You should not pay over that amount, no matter what the total surgery cost was.

Sounds like you need to work out with the insurance why you exceeded that number.

[RaiderRob 3]

Do you have an out of pocket maximum that you have to pay?

[M2G 1,836]

That really sucks (and I can think of some other worse words to use too!)

I'm sorry you are having this battle. I hope there is some relief for you in there when you are done battling. Like Rob said, I hope you can find out if you have an out-of-pocket maximum, because that would certainly help if it is a reasonable amount. Is there a medical insurance board for TX? Keep fighting and I hope you get somewhere with this.

We have a high-deductible (HSA) and knew once we hit the $5K out of pocket for 2010 then everything would be billed at 90% (insurance portion) and 10% (our portion) but what was impossible to tell was what the final bill would eventually be. I was shocked when I logged onto my HSA account a few weeks post-surgery to find out that the bill was over $33,000 for my sleeve (that was just the hospital bill) and I knew that my drs. self-pay price was $20,000. I cannot for the life of me figure out how anyone can get away with that. However, NO ONE will be paying that large of a bill. The discounts were huge, it really is all rather silly to put that on paper knowing full well that NO ONE is paying $33,000.

I'm still not sure I understand how it all works, but thankfully we didn't even have to pay 10% of that price. We only paid 10% of the "discounted" price...phew!

[DallMike 0]

I have Aetna PPO. The deductibles and coinsurance would have been met, but they are not crediting the surgery towards those limits. Aetna is paying 50% of billed charges and I am being stuck with the rest. Since it is insurance it seems everyone, including the surgeon, bills triple so they will be paid near the advertised cash price and then have the audacity to bill for the balance.

Another funny story...my surgeon wrote an order for follow-up bloodwork and gave me the choice of letting the hospital lab downstairs do it or going to my personal doc. Well, geewhiz...since I'm already here...bang! Another $300 bill when my doc would have done it for $20 and wrote-off whatever insurance didn't pay.

The surgery is lifesaving and I know everyone has to make a buck, but I feel like I bought a brand new hurricane Katrina car from Acme A1 Neighborly car lot. Just so everyone knows...I am not a hick from the sticks...I have a degree in finance, former naval officer, and business manager for 25 years. My personality borders on Andy Rooney. I am skeptical of everything and always look for the fine print. I know better than to fall for "trust me". I must be getting senile!