Insurance. Was: Malo and research and suggestions.

[Guest guest]

C wrote:

> ... Don't worry about the insurance out of network thing. Pick the BEST

surgeon, even if it means traveling. They all have financial depts that WILL

work with you to get you in network. Even payment plans!!! ...

There is catch though even if approved, Usual, Customary, and Reasonable

Charges (UCR). What insurance is used to paying is often all they

believe they should pay. Sometimes this does not account for more

specialized or expert care that is give compared to the doctors in their

network. There are also other factors. Even if you are approved to go

out of network the insurance may decide to only pay what they think UCR

is. When in network a doctor or hospital may bill for more than what is

UCR but they will settle for the UCR payment and by contract can not go

after the patient for the difference other than for their standard

co-pay. Out of network the insurance may only pay UCR and the hospital

billing department will go after the patient for the rest, unless out of

kindness they decide to settle for the insurance amount. When an

insurance company tells you that you are approved for out of network

care and they state that they will pay as in network remember than in

network they pay UCR. This is not the same as saying you are fully

covered. Sometimes insurance will pay an out of network charge in full,

but it can be hard before the charges are paid to know how much will be

covered. On a $30,000 bill for a myotomy they may pay it completely or

they may say that $10,000 is UCR. If it is an 80/20 plan then they pay

80% of the $10,000, or $8,000 and leave you owing $22,000.

That said, you have to weigh how much expert care is worth.

If you want to see a hospital's information on this here is an example:

Mayo Clinic Mn.

Billing FAQ

http://www.mayoclinic.org/billing-rst/faqs.html

Charity Care

http://www.mayoclinic.org/billing-rst/#financialassistance

BTW: we don't hear much from Mayo patients in the group, other than me,

but they do myotomies, dilatation, Botox and esophagectomies.

See:

http://www.mayoclinic.org/achalasia/

http://www.mayoclinic.org/achalasia/treatment.html

http://www.mayoclinic.org/esophagectomy/

I am not saying they are better or worse than anyone else, just an

example and an option.

notan