Friday, November 23, 2012
Surgery Cost
So I just got a letter today from the surgeon's office saying the total cost was only going to be $6450! With my insurance covering (hopefully) 80% of that I'm only going to owe like 1200 or so. That is like nothing compared to what I was expecting. I'm hoping this includes everything like all hospital costs and all. It just says on the letter that they have sent a copy of this to the insurance company too. I'm pretty confident that includes everything though so all I can say is wow. They give you an extra 5% off if you pay it all in full before the surgery so I'll probably take advantage of that as well. I might only wind up owing 900 or so which is awesome. I'm expecting to hear from the surgeon's office next week in order to plan a date so I'll post again soon!
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Do you have an annual out of pocket cost each year? If you do that is the MAX you will have to pay.
ReplyDeleteMy hospital bill came separately from the surgeon's office. I may have made a post about this but if I recall correctly, my surgeon's fees were about $8k per jaw. The hospital bill was a whopping $60k+ but fortunately with insurance almost everything except deductible and co-pays were covered. I hope your bill includes the hospital fees, that would be awesome!!!
ReplyDeleteOh no!!! Crap I knew it couldn't be that cheap! Well I still haven't heard from them yet about a date and whether or not it was even approved. Did you get the bill before or after the surgery?
DeleteFirst, let me apologize for worrying you, please don't! I will tell you a few things that should reassure you. The first one being that yes I did receive a quote from the hospital and surgeon's office before the surgery so I had a general idea of what I would be responsible for. I didn't realize how much would be billed to insurance however, but I did know what I would have to pay. In my case, that was the deductible ($1,000 total). Also, your surgeon's office can give you the "CPT" codes now so that you can call the patient financial services dept of the hospital and get an estimate now. They will use these codes to give you a general idea then they will tell you your likely cost based on the insurance you carry.
ReplyDeleteSecond, a great place to look is your insurance provider's coverage booklet. This is a pretty thick document (not the summary of benefits but the actual Plan Document itself). You are allowed to receive a copy although it's not something you would generally obtain from an employer at enrollment. If you have online access, you should check there first. Then, if you still can't find it, you can call the number on the back of your card. Depending on how smart the cookie is on the other line, you may or may not get the right document which is why I recommend going online first to see if you can find it yourself.
Next, if your insurance doesn't cover 100%, don't worry because 100% of the time when insurance covers any part of the surgery there is what is called a Contractual Adjustment to the bill. The two parties have a contract with each other (your surgeon has one with the insurance provider as well) and it's customary for the bills to be reduced to about 60%, sometimes more, of what was billed to insurance.
Finally, for those without insurance and for those who have insurance but less than 100% of the surgery is covered, the remaining balance can and should be negotiated with the hospital. In 100% private pay cases, typically what is paid by the patient is 40%, on average, of what is billed. If some is covered by insurance, the percentage will vary.
I hope this helps and if you have any additional questions feel free to ask. Also your surgeon's office is likely a great place to address any of these concerns because their office should be pretty adept at submitting insurance claims and negotiating contracts with carriers. The surgeons also have contracts with the hospital so they should have a general idea of your out of pocket costs, even what is due to the hospital.
I appreciate the feedback! I know my insurance will cover 80% of the total cost no matter what. I was just assuming that maybe that was it but from all that I've read the hospital bill is what really gets everyone. I have heard that the most out of pocket I'll have to pay is $2500 from other employees but im not sure if thats true or not. I'll have to call the surgeons office first on monday to see if they've heard anything from insurance and ask them about the process a bit more. Thanks again for all the info, I will be putting it to use for sure!!
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