Discounted Rate?

[Policeman116 0]

As I stated last my insurance will only cover $15000 total for weigh loss surgery. I got a estimate today for $23000. I was told by the hospital that they have a agreement with my insurance for a discounted price. The problem is they told me they could not tell me what that price is because it is a agreement with the insurance company and them.

So I called my insurance company and asked them. They also stated I was not "privileged" to that information but they have entered agreement with the hospital for a discounted price. I asked why I can't get that information and they told me it was confidential.

So I became a jerk and told asked them what right do they have to withhold information. Long story short I talked to mutable supervisors and got no where.

Any suggestions?

[RestlessMonkey 7]

Why not, instead of asking for the discounted rate, ask the hospital how much you will need to pay out of pocket?

For an insurance company to contract with hospitals and surgeons for special rates is NOT uncommon. For you not to know your own out of pocket, is.

Does your insurance have a deductible? a Co Pay? If you can tell me this, I maybe can help you.

[susan1961 0]

That is a common practice. It is not meant to withold info from patients, but from competitors; the hospital negotiates rates with multiple different intermediaries. I agree with the prior poster; what you need to ask is what your share of charges will be. THAT they should be able to tell you. Good luck. You are persevering, and that's a good sign, and I am confident you'll make this work!

[Policeman116 0]

My deductible is $200 and when I reach $500 they cover 100% up to $15000. I asked how much it would be out of pocket and was told they can only give me a estimate of $23000. She said they they will not tell her the negotiated amount because they will not tell her. Total out of pocket would be around $8000. They want a total of $5000 down.

A side note is that they have a self pay package of $19500. I am just hoping they will take the $15000. I am willing to pay for the fills and doctor visits.

I hate dealing with insurance. I don't understand it. I don't get sick. I am in good shape just kinda well, fluffy.

[RestlessMonkey 7]

Do you have an insurance advocate or "person" in your HR department? IF so, make an appt, go to him/her, and get some help. If you pay tha $200 deductible, then how do you get to $500? Do you pay 20% of some charges and they pay 80, for example? And do they have a "network" of surgeons and hospitals?

You need someone who "does" understand insurance to sort this out for you, and that should be someone in your HR department.

for example, because I used an "in network" surgeon and hospital, my insurance paid them a contracted amount. ( don't know how much that is...it's a deal between my insurance and them) I paid my deductible and then my "co pay" portion (that's 20% of "covered" charges). Once I reaced a maximum copay (in my case, 3000) my insurance covered the rest. They will only pay so much for lap band surgery. NOT what the doc or hospital wants to bill, but the amount agreed upon (it's contracts) So WHATEVER the hospital and doc want to bill, the max I will pay is 3000 (that catastrophic cap)

Since I'd already met my deductible and had other charges, it ended up being less. IF the doc and hospital tried to charge me more, that would be illegal.

You are in another state (not familiar with Ind. laws) and since you are a cop, if you're like here, they have a union and negotiate benefits. You should have a rep or HR resource to go to to help clarify this for you. I still think your potential max outlay will be $500 (like mine was 3000) and they can NOT charge you any difference, but it's kind of like sorting potatoes in a dark room...if you know what I mean.

Don't give up....see your HR advocate.

[Policeman116 0]

My surgeons assistance is forwarding the issue to the bariatric center. She has been a god sent and she has been fighting for me a lot. As for my department, the person in human resources that job is to fight the insurance company is a tool. She finds ways to keep us from having stuff like this. It is a appointed position.

[RestlessMonkey 7]

Well I'm betting your surgeon's assistant has a good handle on what needs to be done, and with her in your corner, you at least have a fighting chance. Sorry about the other person...that's pretty vile. I'll cross my fingers that something works out for you!