Our Costs after insurance

[RebecaSparkles 247]

Hello,

So, trying to calculate how much my portion of the bill will be after my insurance's negotiated rates...

I have a 30% co-insurance and a $1000 deductible.

I suspect I'll be staying overnight and thus not be able to be billed as outpatient services and instead will be billed as inpatient services?

I know I'll be paying my deductible and the co-pays are fine. I can handle those.

Just worried about getting a $4,800 bill for 30% of a 16K surgery/hospital stay.

For that price I can go to Mexico and not have to jump through hoops.

So, for those of you with insurance how much did you have to pay?

[makemyownluck 785]

Most insurance has a cap to your out of pocket expense (your 30% portion). Have you checked that out with your carrier?

[ereneeh 77]

The hospital told me the day of check in that I would receive an additional discount if I paid my copay the day of surgery, approx. $3200. Anthem Blue Cross ended up paying more than they calculated, so I received a refund. I ended up staying 2 days and I believe my hospital bill at 30% was about $1200. You would be surprised how much is discounted because of the insurance contract.

[makemyownluck 785]

ereneeh makes a good point. If you don't have an out-of-pocket cap, your insurance carrier will likely reduce the allowable amount by half, or maybe more. I just got my statement for my upper GI. Hospital billed $1400, the "allowable" amount was $475. Same with the lab work. Hospital billed $1300, insurance knocked it down to $425.

[brandy88 151]

My bill was 35,000 and I'm paying 1500 out of pocket but like others said depends on insurance. I also had gallbladder out at same time.

[DEZ1975 170]

I paid a $200 processing fee to my surgeon's office, and that was it!

[swampdonkey 36]

My surgery was 36k they want 2100 for my deducible , I negotiated that down to $1150

You can negotiate you deductible in most cases so don't expect what they are telling you owe.

[ISleevedIt 380]

Hello,

So, trying to calculate how much my portion of the bill will be after my insurance's negotiated rates...

I have a 30% co-insurance and a $1000 deductible.

I suspect I'll be staying overnight and thus not be able to be billed as outpatient services and instead will be billed as inpatient services?

I know I'll be paying my deductible and the co-pays are fine. I can handle those.

Just worried about getting a $4,800 bill for 30% of a 16K surgery/hospital stay.

For that price I can go to Mexico and not have to jump through hoops.

So, for those of you with insurance how much did you have to pay?

Rebeca, you will be going through Surgical Associates as I did. With my company, I had to pay $5.00 copay to the surgeon, but here is a breakdown of benefits that I received from Kaiser. It shows the billed amount and the allowed amount. Kaiser paid the allowed amount.

Virginia Hospital Center/ Hospital Inpatient (Incld Part A MC) Admit/Discharge

Billed Amt 19,939.95 Allowed Amount 11,433.29

James Mayes / surgery

Billed Amt 4,950.00 Allowed Amount 1,664.84

James Mayes / Office-other outpatient

Billed Amt 261.00 Allowed Amount 132.17

Charles Gandy / anesthesia

Billed Amt 2,125.00 Allowed Amount 1105.00

Jihad Salameh/ medicine

Billed Amt 110.00 Allowed Amt 88.08

---------------------------------------------------------------------

27,385.95 --- 14,423.37

[sknyinside 99]

Also, even if you stay overnight, if it's less than 24 hours it CAN be outpatient. However, the hospital has to actually bill/code it as an outpatient or observation stay. With a surgery, even less than 24 hours, it will probably be billed or coded as inpatient. A few variables, but the hospital may be able to clarify that ahead of time for you.

[RebecaSparkles 247]

Okay so I followed y'alls advice and I found a nifty ask member services messaging button on my insurance's website. I emailed them and asked for a quote of what my costs could be. Here's what they wrote.

Dear Ms. BANKS,

Thank you for your inquiry.

The gastrrectomy generally costs around $3000; your benefits would require you to satisfy a deductible of $1000 by paying the first $1000 out-of-pocket, then you would be responsible for just 30% of the remaining charges. if the math and price quote stays consistent, then you can expect to pay about $1600 [worse case].

So... not bad. I did get info that you can sometimes ask the hospital to negotiate your co-pay/co-insurance. I'll totally try that. Worst case, they say no.