Insurance deductible and oop question

[GoingRogue 53]

I am an insurance dummy. My doctors office basically told me what I would need to know about but now I'm wondering what I may have to pay at the time of the surgery. I have almost met my deductible but I know I haven't met my oop for the year. Will I have to pay what's left before my surgery? If so I am totally screwed. Looking at a surgery date near the end of September.

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[bia1nca1 38]

My experience with BCBS is they will pay 100% if I have met my deductible and out of pocket max for the year. If I have reached my $3k deductible then they pay 70% and I pay the remaining 30%. I am $400 from my max so that is all I will pay.

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[chycky 671]

All policies even with same carrier can vary. Once you are told it is approved they will likely tell you what amount you are expected to pay day of surgery. Once approved you could call your plan to be proactive and confirm.

I had an employer bcbs I had no deductible so it didn't matter what I had spent so far but I had a $300 flat copay.

[Monet08 63]

It really depends on how they cover hospital charges and also physician services being done in a hospital. You'll either have to pay the coinsurance amount or maybe a copay. If your subject to your deductible you will have to satisfy that first so that will be the amount needed

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[gemigirl 134]

My deductible is $300 and my max out of pocket is $1500. With all the pre-op appointments I'm just about to that $1500, and I already worked out a payment agreement with the hospital to pay $100/month.

[anrobe 34]

Definitely call your insurance company. BCSB of NC told me that I'd have to pay what's remaining of my $1150 deductible PLUS up to $500 of my portion of the full surgery which is 10%. So, my total out of pocket will be $1650. My undersanding is that the hospital will want to be paid my portion before surgery but I believe all hospitals are different. You may want to call the hospital to ask how that works if you want to be sure. I was told to plan to owe that $1650 on the day of surgery.

[missvee 28]

I called and called and called my insurance carrier even after my doctors office reviewed by benefits with me just to make sure! You can always log on to your carriers website and they should have a breakdown of what's covered and what patient responsibility is. I knew I had a $200 copay for the hospital by looking at the benefits online and 1 week after I got my surgery date received a letter from the hospital to be prepared to pay that on the day of the surgery. Anesthesia is a separate benefit as well as the doctor that will be administering the anesthesia. The surgeon performing the surgery is also a separate benefit so go over that with his office directly, I only had to pay my copay for his services.

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