FINANCIALS ?

[allycatt98 35]

I don't understand why so many people are shocked by the fact they have to pay the surgeon up front or pay their deductible up front. The surgeon usually has an up front fee. I am have had six surgeries and have always had to pay an fee before surgery. Sometimes they would send it back to me, sometimes they wouldn't. I'm just glad I have met my deductible and out of pocket before my wls. Not trying to be rude, but some of you obviously don't understand how insurance works, give them a call they can explain everything to you.

I am not ignorant of my insurance. Completely the opposite. You must be lucky and not have a large out of pocket.

I know how much everything costs and what I will pay at every moment. And that is why I will never pay a penny, nickel or dime up front. If I am cash pay then that's different. But with deductibles it's all about who gets the bill in there first. I am not willing to give a hospital or doc several thousand when the anesthesia and radiology will get in first. I will owe them that money.

So I pay when I get an EOB or a bill and never up front.

That happened to me once 5 years ago. I was $4500 away from the deductible so i paid $1000 to the hospital up front with promise to pay $1000 a month after.

Well surprise I got was anesthesia doc charged more than hospital stay was allowed. No joke. The anesthesia charges were $18.000. And the hospital allowed from insurance was $4800.

Anesthesia was out of network so they got paid and wanted my deductible, and guess who got his bill in first? Needless to say hospital got fully paid and took me 90 days to get a refund from them.

Anesthesia took a lot longer to come to an agreement and a formal filing of complaint with the medical board for excessive fees. I paid them nothing. They put it on my credit report I filed another complaint and lawsuit.

I understand your methodology, but how often are you able to get away with it? I don't want to, but I often get stuck paying the "estimated" fee and getting refunded later. I'm definitely EOB happy and glad to see that I'm not the only one. My surgeon's office initially told me that my consult would be $240, but later decided to just bill me once they receive the pre-determination estimate from insurance. Just got my EOB and my responsibility is only $94. ; )

[allycatt98 35]

How about my surgery is on Tuesday and the hospital just called and told me that I have to pay my entire $2,000 deductible on Tuesday before surgery. After I freaked out, I told her I don't have it and that's not what I was told. She said, ok pay $250 and we'll bill you for the rest, but you can make a payment arrangement. Nowadays the hospitals are asking for the deductible up front because they've been stiffed too much by people who don't pay theirs. I understand, it's not charity, it's a business, but damn, springing that on people at the last minute is not cool. I know that I'm going to be getting loads of bills from the hospital, the anesthesiologist, the surgeon, etc., but I don't care. Nothing, and I mean NOTHING is going to keep me from my surgery on Tuesday. I'll be paying bills until I die, but with this surgery I'll be paying bills much longer and that's ok with me:)

Do you have an out-of-pocket max? If so did they ask for that at any point. I'm asking b/c my deductible is $500 which I've just about met and I have an o-o-p max of $2300. I'm thinking the hospital may ask me for that also. I know they all are differs just wondering what your experience was. I'm still waiting on my approval and don't want any surprises! Lol

Keedy,The hospital should not ask you for your entire MOOP. What is your co-insurance after deductible? For most people it's usually 20-30%. Your payment/deposit to the hospital should be based upon an estimate of your co-insurance responsibility of the "negotiated" fees. Your insurance company should be able to provide you an estimate of the negotiated amount. Then figure out your responsibility and try to haggle a deposit/payment with the hospital. Additionally, I would take in any proof of payment to the physician. Because your MOOP at the time may not be reflective of payments.

[Jersrose43 837]

I understand your methodology, but how often are you able to get away with it? I don't want to, but I often get stuck paying the "estimated" fee and getting refunded later. I'm definitely EOB happy and glad to see that I'm not the only one. My surgeon's office initially told me that my consult would be $240, but later decided to just bill me once they receive the pre-determination estimate from insurance. Just got my EOB and my responsibility is only $94. ; )

Always!!

I stick to my guns and I explain again and again they don't know my situation. They don't know what other care my kids are getting or my husband. They don't know the cost of my prescriptions. Bottom line these insurance coordinators are great but they're not holding a crystal ball over everyone else's charges and how fast the insurance company gets a claim and pays a claim for someone else.

You refuse enough times up front and pay on time when you get the bill, they'll respect your no.

[allycatt98 35]

I understand your methodology, but how often are you able to get away with it? I don't want to, but I often get stuck paying the "estimated" fee and getting refunded later. I'm definitely EOB happy and glad to see that I'm not the only one. My surgeon's office initially told me that my consult would be $240, but later decided to just bill me once they receive the pre-determination estimate from insurance. Just got my EOB and my responsibility is only $94. ; )

Always!!

I stick to my guns and I explain again and again they don't know my situation. They don't know what other care my kids are getting or my husband. They don't know the cost of my prescriptions. Bottom line these insurance coordinators are great but they're not holding a crystal ball over everyone else's charges and how fast the insurance company gets a claim and pays a claim for someone else.

You refuse enough times up front and pay on time when you get the bill, they'll respect your no.

This is so true. UHC has online estimates for Gastric Bypass and Lap Bands, but no sleeve. I requested a pre-determination so we're all on the same page. I've still got summer vacation to pay for