How to determine amount of insurance coverage?

[Candle 11]

This just doesn't seem right to me ...

I had a consult w/ a surgeon back in Jan. I don't think I plan to pursue surgery with THIS doctor. His office staff was very nice and helpful - they submitted a request to my insurance just to see if they will cover any part of PS.

To my surprise and delight - they will cover the panni portion of the TT. I have an approval letter for code: 15830- panniculectomy. The surgeon suggested an extended TT and I was quoted $9,500. He is out of network, so I know my coverage is 70% of the contracted rate, after a $2,000 deductible. No one from my insurance co or the doctor's office can tell me how much I will be liable for.

I'm expected to go into surgery and not find out until AFTER if I have to pay anywhere from $2,000 - 9,500?

[Dr. Schulman 2]

This just doesn't seem right to me ...

I had a consult w/ a surgeon back in Jan. I don't think I plan to pursue surgery with THIS doctor. His office staff was very nice and helpful - they submitted a request to my insurance just to see if they will cover any part of PS.

To my surprise and delight - they will cover the panni portion of the TT. I have an approval letter for code: 15830- panniculectomy. The surgeon suggested an extended TT and I was quoted $9,500. He is out of network, so I know my coverage is 70% of the contracted rate, after a $2,000 deductible. No one from my insurance co or the doctor's office can tell me how much I will be liable for.

I'm expected to go into surgery and not find out until AFTER if I have to pay anywhere from $2,000 - 9,500?

In general, 15830 will reimburse about $1800 - $2500 (obviously this varies among insurance providers, but this should give you a "ballpark" idea). It is possible that this will go towards you deductible and you will only get a small amount of reimbursement. Your PS office should have been able to give you an idea about this amount, because they have probably experienced this before.

[Candle 11]

Thanks Dr Schulman

I was thinking it would cover about a 1/4 to a 1/3 of the cost.

I'm coming to see you in April. I had to cancel my appointment this month, emergency gall bladder removal on St Patty’s Day.