Out of Pocket and Deductible Question?

[darneka1 20]

I got approved for my Gastric Sleeve procedure by Blue Cross Blue Shield of Georgia in January. I called my insurance to confirm the details of my deductible and out of pocket amounts. I had an interesting conversation with the customer service agent. My individual deductible is $350 and my out of pocket maximum is $2890.00 ($350 of that amount is the deductible). My plan covers the Gastric Sleeve at 80% and I am responsible for 20%. My confusion is that the financial coordinator for my surgeon states I have to pay $2890.00 at the date of my surgical interview (happens about 3 days prior to surgery) but my insurance states that the procedure can happen after I pay the deductible which is $350.00. and that I would essentially be responsible for 20% of the procedure once it was completed as the amount would be unknown until after it was done. My confusion is why am I paying the full $2890.00 before I have the procedure if my insurance states they would pay for the procedure after the $350.00 is paid. Has this happened to anyone else?

Any advice or clarification would be appreciated. I hate insurance...so confusing..

[jujubslim 95]

Is that 2890.00 for the dr or hospital or both?

Here's what you need to ask the financial counselor. Ask for the total amount that is covered by your insurance company. Once they give you that amount you'll be able to figure out what 20% is. If 20% is less than the 2890.00 I'd call your insurance and let them know they're billing you for more than the contract amount. If the 20% is greater than 2890.00 that's why they're charging you the max before surgery and they're entitled to collect up front.

[Kking1205 21]

I have bcbs federal and I had to pay my deductible up front plus 2377 for my 20 percent of the surgery I was responsible for. It wasn't the policy of bcbs but of the hospitals.

[Kindle 8,667]

A friend of mine just had a hysterectomy and they required the full amount of her out of pocket max before surgery. They said if there was anything left over after all the billing was done they would refund her. Sounds like it may just be a common hospital billing policy.

[dharriott 37]

I got approved for my Gastric Sleeve procedure by Blue Cross Blue Shield of Georgia in January. I called my insurance to confirm the details of my deductible and out of pocket amounts. I had an interesting conversation with the customer service agent. My individual deductible is $350 and my out of pocket maximum is $2890.00 ($350 of that amount is the deductible). My plan covers the Gastric Sleeve at 80% and I am responsible for 20%. My confusion is that the financial coordinator for my surgeon states I have to pay $2890.00 at the date of my surgical interview (happens about 3 days prior to surgery) but my insurance states that the procedure can happen after I pay the deductible which is $350.00. and that I would essentially be responsible for 20% of the procedure once it was completed as the amount would be unknown until after it was done. My confusion is why am I paying the full $2890.00 before I have the procedure if my insurance states they would pay for the procedure after the $350.00 is paid. Has this happened to anyone else?

Any advice or clarification would be appreciated. I hate insurance...so confusing..

So what did u find out?