Just got my bill and got a surprise

[MissLiss 71]

So, my insurance only covered $1800 of the $15,000 surgery because the doctor I chose was out of network but he offered to reduce his fee to $5000 leaving me with $3200 that I would pay off at $100 a month. He has an excellent reputation, I felt in very good hands. Everything else was in Network. Today I received the bill I was waiting for and it shows the reduced fee for my doctor and a $14,500.00 charge for a second doctor who was never discussed, not a fee for her, she is his PA. The office was closed by the time I received the bill so I will call tomorrow.

I am definitely feeling some anxiety though. I will fish out my original paperwork tonight.

[wannaBthinsoon 1,634]

Holy smokes! Good luck!

[gigito2 52]

Yikes! I hope this is a mistake.

[MissLiss 71]

I'm thinking it is a mistake. He is a reputable surgeon. I am hoping it's something they submit when its covered by insurance.

[Daisee68 2,493]

If it makes you feel better, I had a charge for my dr's PA also in the operating room. I think it's fairly standard, but if he had previously agreed to the earlier arrangement, I am sure he will honor it and someone at the office just billed you wrong. Hope that is what it is anyway!

[RickM 1,753]

Certainly touch base with your surgeon, and particularly the insurance coordinator in his office. Lots of things get billed and ultimately adjusted as they go through the insurance process (there are lots of inflated charges that get submitted that no one seriously expects to get paid in full - it's part of the game.

My surgeon is also out of network (though the hospital was in network) and I paid him up front, but by the time the insurance got around to paying things, the max out-of-pocket level of the policy had been reached and they paid his fee 100% even though he was out of network.

Here's hoping that yours shakes out as well.

[sleevenv 483]

I was cash pay in the U.S. At a bariatric excellence center and the surgeon got $4,000 and the assistant got $400. Tell them that's what you're willing to pay!

[MissLiss 71]

Good News! I spoke with the office and even though the bill was sent to me it was generated for insurance...The only reason I received a copy was so I would be aware to send in the check to them when it came from Insurance...A few extra words indicating this on the statement would have been appreciated...but what is appreciated more is I am not expected to pay it. Phew!

[pinkbunies 359]

$14,000 for a PA is a little bit too high. Wow.

[sandyb68 46]

You are lucky. My insurance did not cover this, so all up I am out of pocket at $18k so far. My issue, I didn't have to go this route, but I did. Sour grapes for me though is 5 months later my work just announced they are now including this in our insurance plan. I guess my two years of writing them and bitching will pay off for the next person. You're welcome ????

[Phosphate 10]

I'm self pay my bypass is $20,000 was originally $18,500 they told me I need my gallbladder removed which is another $1,500 ugh!! I figured $18,500 would include gallbladder removal since almost all bypass surgerys removes the gallbladder.

[RickM 1,753]

$14,000 for a PA is a little bit too high. Wow.

Everything as billed is "too high" in this business - it's part of the game. What's important is what is actually paid under contract, which for this item will probably be in the $1500 range.

You are lucky. My insurance did not cover this, so all up I am out of pocket at $18k so far. My issue, I didn't have to go this route, but I did. Sour grapes for me though is 5 months later my work just announced they are now including this in our insurance plan. I guess my two years of writing them and bitching will pay off for the next person. You're welcome

We had much the same thing happen with my wife's DS - about a year later Medicare started covering it which meant that the insurance companies could no longer use the "investigational/experimental" dodge that they often use. An RNY or band would have been fully covered, but she wasn't going to go there. The 30k we paid for it bought her an extra couple years of much improved health.

[The Candidate 3,215]

My co pay for the surgery will only be $250, and I don't have a deductible. I know that I'm very lucky. I will be interested though to get the actual break down of costs after the fact. I had to go to the emergency room not too long ago to have an abscess drained. It took like 15 minutes and my co pay for that was only $100. When I got the breakdown later of "actual" costs it was over $2000! It's ridiculous and a crying shame that a lot of people who can't afford insurance go broke just trying to get healthy!