Guess How Much They Billed My Insurance...

[wannabb08 17]

Let me preface this: I stayed in the hospital a total of 6 days/ 5 nights. I had complications from sleeve swelling and nausea.

Surgeon: $5000

PCP (He checked on me 3 days) $600

Hospital: $54,392

Holy cow!!!

So far the PCP claim has been paid. Other two denied - they need my medical records or something like that. I can check the claim status online.

I have $0 copay for the surgery. I should be billed $200 a night for the hospital day for a max of 3 day. ($600 total)

I'm going to call my insurance on Monday to get more info on why the surgeon and hospital claim have been denied.

I'm a little nervous.....that is a crazy amount of money!!!!!!!!

[2bsmallagain 156]

I wouldn't panic. When they approved the surgery they entered into a contract with the surgeon to pay for it. They will bicker back and forth about what will be paid and you should only have to pay what you originally would have paid.

[Mab 44]

My hospital stay is $37000 and of that I had to pay (up front) 10%. That doesn't include my surgeon and anesthesiologist. I'm to be sleeved on 4/10 and I expect to be treated like a GODDESS for that amount of money. We're talking massage, mani/pedi, around-the-clock back scratching...

Your surgery bills are the last thing I would worry about if I were you (unless they need to be paid up front). Once you get billed, make payment arrangements. They're usually pretty nice about it as long as you pay according to your payment schedule.

[Caradina 65]

Yeah, this is why the American healthcare system is so messed up. WTF costs that much money? Seriously!

[PogiYogi 2]

My hospital stay is 37000 and of that I had to pay (up front) 10%. That doesn't include my surgeon and anesthesiologist. I'm to be sleeved on 4/10 and I expect to be treated like a GODDESS for that amount of money. We're talking massage' date=' mani/pedi, around-the-clock back scratching...

Your surgery bills are the last thing I would worry about if I were you (unless they need to be paid up front). Once you get billed, make payment arrangements. They're usually pretty nice about it as long as you pay according to your payment schedule.[/quote']

Most insurance health care plans do not require patients to pay upfront for any services you may wish to contact your insurance provider to find out more details regarding this I am married to a doctor and I understand her contractual obligations with these insurance companies do not require any of her patients to pay upfront out-of-pocket until an explanation of benefits has been sent to the patient generally this is post procedure

[Terry H. 196]

I was required to pay my deductible max up front ($400). My coverage was 50% after the deductible up to a max of $10K. Self-pay was $14,500 so I figured I was set and would pay about $7 or$8K. But no - the charges agreed upon by the hospital and my insurance exceeded $20K by quite a lot. So I ended up paying about $11-12K out of pocket - yes, nearly as much as if I didn't have any insurance. That was after the hospital gave us a discount for prompt payment. So here is my lesson learned. Make each provider in the chain estimate how much the charge will be prior to surgery and don't make any general assumptions. Don't rely on the surgeon's office either as they don't know what every provider (hospital, anesthesia, etc..) will charge and have agreed upon with the insurance company. I would have paid every cent I did to get the surgery btw, but I just wasn't prepared for the size of the check I had to write.

[chasitybeatty 1]

Ur lucky I had to pay cash my insurance didn't cover it!!!

[2BonederfulAgain 17]

Let them work that out...They approved it!

You are only responsible for your co-pays deductibles etc, if not otherwise outlined in your benefits package. Dont worry about it--that isn't your battle (worked as an insurance broker for health insurance and non profits before)

Focus on your diet and LOSING

[PogiYogi 2]

If you're a doctor is contracted with any of the major insurance healthcare providers he is contractually obligated to follow all of the conditions and terms within the contract between himself and insurance company I have yet to see a contract that allows a doctor to collect for services that have yet to have been rendered you doing this is voluntary is not a requirement in fact many insurance companies will threaten to drop a medical provider if they're doing this as they're not following the guidelines that the insurance company has set forth I know matter fact that many patients don't know this contact your insurance company ask them yourself. There are times in which errors are made in billing most doctors have different contractual financial arrangements with different insurance companies some insurance companies will pay out more than others you can even contact your State insurance commission and have them explain this to you just as believe it or not a doctor which dosen't collect insurance co-pays can also be dropped from insurance provider. doctors must play by the rules which they agreed to when they contracted with insurance companies and you as a patient must protect yourself and your assets at all times what happens in the event that there is a situation where there's the possibility of litigation postoperatively with the patient do you still want to pay the doctor. I probably shouldn't be sharing this information with you but I would say patients need to empower themselves and protect themselves at all times for doctors regardless of what they think it's about following rules and doctors and follow rules just like we patients have to comply with the rules just remember if you choose to pay before surgery then that is voluntary good luck getting your money back if in the event something were to happen for example you decide you do not want the surgery you passed away you want to put it on hold whatever the reason maybe there could be a problem getting your money back and this is why the insurance companies have set forth these rules within the contract that the doctors should follow. GOOD LUCK!

[kczar 166]

Umm, not sure about that Pogi. Maybe in California, but I don't think that's the case everywhere. I'm in Texas and this year I had gallbladder surgery and an endoscopy, both of which were subject to deductibles and copays. Different doctors, different hospitals. With each doctor, I had to pay a down payment based on the projected copay as determined by my insurance. Hospitals, same thing. They contacted me with my estimated portion and I had to make a down payment and agree to set up a payment plan once insurance had been filed and my balance due was finalized.

In my initial visit to the surgeon to discuss WLS, I met with the insurance coordinate and given the projected copay I would be responsible for and told that payment was to be completed before surgery would be scheduled. Lucky for me my gallbladder and endoscopy covers my OOP maximum so my sleeve will be free!

Just wanted to share my experience with insurance to give another perspective.

[Bypassjourney 88]

My doctor's office charges about $14K for self pay patients. As far as my understanding from others that used this doctor that was a "package deal" that included pre-op hospital tests, hospital stay for two nights, anesthisiologist, doctor. Basically everything. I have insurance so I only had to pay $2,100 which was my annual out-of-pocket maximum. But I am still shocked at how much was billed and paid. The hospital billed $100K and my insurance company paid a negotiated rate of $67K!! Between all the individual doctors that submitted a claim while I was in the hospital and my surgeon, anestisiologist, etc. my insurance company paid out a total of $83,000. Seriously? That is just unbelievable to me. No wonder our health care system is in such horrible shape. I am so thankful that my insurance company paid but I almost feel guilty that the doctor and hospital charged them such a ridiculous amount.

[PogiYogi 2]

Umm, not sure about that Pogi. Maybe in California, but I don't think that's the case everywhere. I'm in Texas and this year I had gallbladder surgery and an endoscopy, both of which were subject to deductibles and copays. Different doctors, different hospitals. With each doctor, I had to pay a down payment based on the projected copay as determined by my insurance. Hospitals, same thing. They contacted me with my estimated portion and I had to make a down payment and agree to set up a payment plan once insurance had been filed and my balance due was finalized.

In my initial visit to the surgeon to discuss WLS, I met with the insurance coordinate and given the projected copay I would be responsible for and told that payment was to be completed before surgery would be scheduled. Lucky for me my gallbladder and endoscopy covers my OOP maximum so my sleeve will be free!

Just wanted to share my experience with insurance to give another perspective.

These contract between Insurance and Doctors are pretty much standard across the board the only way to know for sure is for you to call your health insurance and report back here online.

[Georgia 2,908]

• Same thing happened to me ($37,000) I had already paid my $200 hospital co-pay and $150/surgeon copay. But waiting and watching that $37,000 sitting, sitting, sitting there was VERY nerve wracking, but ALL was paid. Fed BCBS.
  

[PogiYogi 2]

If your prepaid that's because you volunteered to do so. Call your insurance company and report back. I know some doctor are going to pretty pissed off that their dirty little secret is out now. But hey if they want you to trust them, then they must trust you. See how that works.

[deltadawn817 106]

They might bill that much but they won't get paid that much. You helth insurance might need some explination of some charges even maybe just one. If that is the case they will deny the whole bill. I had knee surgery and one part of it was billed at $67,000 but insurance only paid them $32,400.