Can anyone tell me what this means?

[Kristin07 0]

Hello! I have Blue Shield ppo 750, and I looked up what they cover for Bariatric surgery and this is what it says.

<LI type=square><LI type=square>Prior Authorization: Required These provider networks are available under your plan. Provider Network: Preferred Provider

• Copay: $250.00 plus 30.0000000000% Per Admission, after deductible is met. Copayment maximum applies.
  
• Applies to Deductible: Yes. Applies to Preferred Provider deductible

I understnad the copay but what do they mean by 30% per admission after deductible is met? Does this mean i have to pay 30% of the surgery cost? Please let me know!!! Thanks you!!! :help:

[losingjusme 12]

i think if you are admitted (not out patient) but you may want to call your ins company

[faithmd 14]

I concur, I'd call them.

[Kat817 19]

Back when I was trying to get BCBS of TX to cover mine, they would only do so if there was a 2 night hospital stay and some plans DID have a % Pay on top of the met deductable.

Also keep in mind some hospitals even if they are in the network, do not accept assignment I was told. The example they gave me was this.

If my deductable is $500.00 that has to be paid by me.

If I have a 30% co pay on a 10,000.00 surgery, I am going to be responsible for another $3000.00.

And if the insurance only recognizes and pays say $7000.00 of that procedure, and the hospital does not accept the assignment of the payment benefit, then you will also be responsible for the other $3000.00

It sounds crazy---but they get you coming and going!

I am fighting BCBS right now---my DH was in ICU for an extended period of time, and the hospital (he was critical, moving him was not an option) while in network does not accept assignment. Now we have over $18,000.00 difference in what they billed, and BCBS paid, and they are telling me that this is not part of the maximum out of pocket clause. I finally turned it all over to an attorney----26 pages of emails, and contradicting info from the insurance.

Thank God for my lap band, my high blood pressure of days gone by would have blown the top off my head by now!!!!

Good Luck!!!

Kat