Received Insurance Bill breakdown

[christasha 0]

I got my hospital bill breakdown yesterday (2-22). My total bill was $37,044, the discounted amount was $23,897 so the total the insurance had to pay was $13,147. Good grief! That doesn't include the doctor. He had told us that if we were self pay it would be $17,000. I'm assuming my "prostheses" is my actual band . . . cost $9,885, with an insurance payment of $3,508 after discount.

Then today I get another breakdown that says they can't submit payment until they have the provider's name and address . . . OMG . . . they've already approved all this . . . IDIOTS

[lachica39 0]

now I know the reason be hide the high medical cost. my insurance paid $30, 000 to the hospital for 4 hours of care. that is a damn rip-off.

2 years ago I was involved in a MVA and hospital billed my insurance for $12 grand but with discounts ended up charging only $300.

You hear everyday of uninsured families losing everything to pay high medical bills, are they offered these discounts. hell no! something needs to be done in this country

I thank God everyday that I have insurance.

[Fanny Adams 7]

Wow, that seems extremely high, especially the cost of the lapband itself. I was a self-pay in Australia and I know that our medical costs aren't as high as yours, but still - I would have thought that the cost of the band itself would be comparable and mine was $3600 AUD (which is about $3200 US). Actually, I would have thought that it would be more expensive in Aus, because we usually pay much higher prices for manufactured goods than folk in the US do (eg cars, white goods, etc).

I paid cash individually to each party involved, so I know my cost breakdown worked like this:

AP 10cm lapband: $3600

Surgeon's Fee: $2700

Anaesthetist's Fee: $1600

Private Hospital Theatre Fees & Day Bed (including take home drugs and those awful anti-thrombosis stockings, etc): $3700

Lab Bloodwork: $170

Total cost for the day: $11,770 AUD (approx $10,600 US)

I can add to that the $150 for the pre-op visit to the surgeon and then two followup visits for fills ($150 each), and subtract the $1400 rebate that our Medicare system gave (which is very minimal because this was privately done), so far this band has cost me $10,820.

I wonder why the band itself is so much more expensive for you - it's all from the same company and we have higher import duties, tariffs and other taxes than you, I was very surprised by that.

[christasha 0]

You would THINK there would be some charges that are standard no matter where you are . . . but I guess not. I sure don't know how all of this works . . .and I'm glad I don't have to figure it out and my insurance covered it all . . . but omg what a racket to "inflate" costs, then discount them and then come up with what the insurance should pay . . . yikes!

[miztrniceguy 1]

so far, my ins co has been billed $87000, for surgery and one fill. they have pd dr anethesiology etc, $22,200. they were out-of-network, but will adjust to be in-network billing, i will be paying about $600

[antsmith101 0]

Mine right now is 77k but they are telling me that they are missing some paper work that they requested and it past the 45 days and they may not cover surgery.

No way im going to pay 77k myself.

I called them up and they said they needed a operative report... which the insurance lady on phone said she not sure why they still needed that paper work when they already approved surgery. So i gotta wait 3 weeks to get response from claims department if they really need that paper work or can they go ahead...

[christasha 0]

It's unbelievable what goes on! There is a lady on another forum who offers to help with insurance problems if you have them . . . she used to work insurance . . . so let me know if you need her!

[antsmith101 0]

ok thanks

I gotta call them back this week and hopefully everything is fixed.

[karri68 0]

one of my bills was 2071$ insurance paid 1576.62 and a 287.28 discount which I got a bill for 207.10 for out of pocket.

anesthesia was 1360$ ins. paid 901 and discount of 300$ left me 159$ I have a few other for pre op consult., labs ect. but I am still waiting on the big on I have a break down of 38,043.15 waiting on finial tally of that I have a 2k out of pocket max. so I most I should have to pay is around 600 keeping my fingers crossed. But I agree I about crapped when I got this bill , no wonder ppl go to mexico if they don't have insurance it is a rip off I was under only about 40mins, never even got put in a room just stayed in pre/post op area the whole time I was at the hospital left the same day. I figured all the bill total was approx. 43k us dollars

[Redneck 0]

i went to mexico to have my lap band because of the high pricing, but what is this discount i hear about waht is that, and how do i get one:thumbup:

[miztrniceguy 1]

the discount is the lower price they agree to accept from the insurance company after they submit their inflated bill to them.

[Fanny Adams 7]

Mine right now is 77k but they are telling me that they are missing some paper work that they requested and it past the 45 days and they may not cover surgery.

No way im going to pay 77k myself.

I called them up and they said they needed a operative report... which the insurance lady on phone said she not sure why they still needed that paper work when they already approved surgery. So i gotta wait 3 weeks to get response from claims department if they really need that paper work or can they go ahead...

$77K?? $77 thousand dollars???:blushing:

[Done 2]

That is unbelievable! Talk about overinflated health care costs.

My surgery cost 12,812.50 which breaks down to:

$5000 for the band

$5000 for the hospital, anesthesiologist, etc.

$2812.50 for my surgeon

[antsmith101 0]

ya 77 thousand dollar they charged my insurance and im still trying to clear up the mistake of missing paperwork so they will pay off the claim... gotta wait 30day for claims dept to come back and tell me yes or no... blahh

[CMTurner 0]

Hi all. I used to work in insurance. They base payments and agreed upon discounts on the average costs for specific procedure codes in each zip code or area at the percentage your insurance has agreed upon. So they take say the average cost for the actual surgery code in your area and then your insurance "agrees" to pay say 70%, 80% or if you are lucky 90% of that average ( they update this average usually a couple times a year by "polling" physicians, med ctrs, etc as to what they actually charge per procedure code). If the physicians, etc. continually increase what they charge for insurance covered patients they can increase what they actually get paid over time. They also get incentives obtaining or retaining patients from "in network" patients. The contracts for in network services are incredibly detail and complex. LOL. We used to have multiple books (along the lines of small set of encyclopedias) with the breakdowns per zip code and %'s to match up for "allowables" when we had to override the system to pay correct amounts to allow for multiple procedures or verify automated payments were processed correctly. I would definately contact your insurance if you feel they have processed your claims incorrectly. A lot of procedures are set to "automatically adjudicate" (big word for pay). Sometimes the programming doesn't take all the facts into consideration or they don't "pick up on" and authorization. Always watch that they don't exceed your maximum out of pocket amounts and that they pay auxillary services (eg. labs, radiology, anesthesiology) done in conjunction with in network services at the in network level because sometimes you cannot help that the lab, etc is done by out of network providers because you have no say so. Anesthesiology is a big one where this gets overlooked because you don't get to pick them. Hope this helps someone.

And good luck to everyone on their weight loss.