Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 I really like my oral surgeon. He did a SARPE last year on me. My insurance changed in January and he was then " out of network " on my current plan. I like him a lot though and decided it was worth paying a little extra to get him to do this one too (definately lower, maybe upper). On Thursday, I went in for pre-op x-rays and photos. The lady in the office that handles the insurance wanted to talk to me about how much I would need to pay. She told me that in their past experience that even though I was approved by the insurance company (5 weeks ago) for 70% and I would have to pay 30%, that they tend to only get 50% payment from them. That means that I would have to pay $7,000. They would need a $3,000 deposit from me prior to my surgery on Oct 2nd and the remaining $4,000 would have to be paid out over a year. I was in shock. I was not expecting that much. I don't have $3,000 nor can I come up with it in less than two weeks. I left really upset and frustrated. I don't want to start over later or with another doc... Well, I called the insurance company with the CPT (?) codes and charges for the surgery. The insuance company said they were well within the limit of what they consider to be " reasonable and necessary " and they would pay 70%. I called my doctors office back and explained to the lady what the company told me. She said she couldn't believe they said that because that is not what they do.... Well, I am sorry but I am not going to take her word for it. Anyhow, in the end, she talked to my doctor about it and we agreed that I would pay my 30% which is a $4,000 max. I didn't have any problems with them last year so I didn't expect any this time, but I think if I had things to do over again, I would have asked about this earlier. Hopefully none of you have this problem but please do be cautious of what your doc's office says... -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 I had a similar situation with my surgery. My orthodontist recommended a surgeon to me, unfortunately he was " out of network " so I would have to pay 20% of the costs. All of the oral surgeons in my area who were in the network had very little experience doing major corrective jaw surgery. Anyway, I had two surgeries done with my " out of network " doctor and I have never had any trouble with the billing. As fas as I know, the insurance company can't suddenly change their policy after they approve the procedure. They told me they would pay 80% and that is exactly what they did. I agree with you, the woman in the office was probably incorrect. I expect that you'll have no trouble at all and you'll only have to pay 30%. - > I really like my oral surgeon. He did a SARPE last year on me. My > insurance changed in January and he was then " out of network " on my > current plan. I like him a lot though and decided it was worth > paying a little extra to get him to do this one too (definately > lower, maybe upper). > > On Thursday, I went in for pre-op x-rays and photos. The lady in the > office that handles the insurance wanted to talk to me about how much > I would need to pay. She told me that in their past experience that > even though I was approved by the insurance company (5 weeks ago) for > 70% and I would have to pay 30%, that they tend to only get 50% > payment from them. That means that I would have to pay $7,000. They > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > and the remaining $4,000 would have to be paid out over a year. I > was in shock. I was not expecting that much. I don't have $3,000 > nor can I come up with it in less than two weeks. I left really > upset and frustrated. I don't want to start over later or with > another doc... > > Well, I called the insurance company with the CPT (?) codes and > charges for the surgery. The insuance company said they were well > within the limit of what they consider to be " reasonable and > necessary " and they would pay 70%. I called my doctors office back > and explained to the lady what the company told me. She said she > couldn't believe they said that because that is not what they do.... > Well, I am sorry but I am not going to take her word for it. > > Anyhow, in the end, she talked to my doctor about it and we agreed > that I would pay my 30% which is a $4,000 max. I didn't have any > problems with them last year so I didn't expect any this time, but I > think if I had things to do over again, I would have asked about this > earlier. Hopefully none of you have this problem but please do be > cautious of what your doc's office says... > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Harmony, I also had a similar situation. My surgeon dropped out of the network right before I was to have surgery. Fortunately there were no surgeons in the network within 72 miles so the insurance company said they would provide in network benefits for the out of network surgeon. The surgeon's office told me the same thing yours told you. They said the insurance company only pays 50% and I would have to pay the difference. I only had to put down 10% ($1500)and I could pay the difference over time. My insurance company on the other hand assured me they would pay 90%. They also said my total out of pocket was only $500 and they would pay %100 after that. I am three weeks post op and still haven't seen how the insurance company is actually paying. I hope the insurance company keeps their word and I get $1000 back from my surgeon! Am I dreaming? Terri > I really like my oral surgeon. He did a SARPE last year on me. My > insurance changed in January and he was then " out of network " on my > current plan. I like him a lot though and decided it was worth > paying a little extra to get him to do this one too (definately > lower, maybe upper). > > On Thursday, I went in for pre-op x-rays and photos. The lady in the > office that handles the insurance wanted to talk to me about how much > I would need to pay. She told me that in their past experience that > even though I was approved by the insurance company (5 weeks ago) for > 70% and I would have to pay 30%, that they tend to only get 50% > payment from them. That means that I would have to pay $7,000. They > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > and the remaining $4,000 would have to be paid out over a year. I > was in shock. I was not expecting that much. I don't have $3,000 > nor can I come up with it in less than two weeks. I left really > upset and frustrated. I don't want to start over later or with > another doc... > > Well, I called the insurance company with the CPT (?) codes and > charges for the surgery. The insuance company said they were well > within the limit of what they consider to be " reasonable and > necessary " and they would pay 70%. I called my doctors office back > and explained to the lady what the company told me. She said she > couldn't believe they said that because that is not what they do.... > Well, I am sorry but I am not going to take her word for it. > > Anyhow, in the end, she talked to my doctor about it and we agreed > that I would pay my 30% which is a $4,000 max. I didn't have any > problems with them last year so I didn't expect any this time, but I > think if I had things to do over again, I would have asked about this > earlier. Hopefully none of you have this problem but please do be > cautious of what your doc's office says... > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Harmony, I also had a similar situation. My surgeon dropped out of the network right before I was to have surgery. Fortunately there were no surgeons in the network within 72 miles so the insurance company said they would provide in network benefits for the out of network surgeon. The surgeon's office told me the same thing yours told you. They said the insurance company only pays 50% and I would have to pay the difference. I only had to put down 10% ($1500)and I could pay the difference over time. My insurance company on the other hand assured me they would pay 90%. They also said my total out of pocket was only $500 and they would pay %100 after that. I am three weeks post op and still haven't seen how the insurance company is actually paying. I hope the insurance company keeps their word and I get $1000 back from my surgeon! Am I dreaming? Terri > I really like my oral surgeon. He did a SARPE last year on me. My > insurance changed in January and he was then " out of network " on my > current plan. I like him a lot though and decided it was worth > paying a little extra to get him to do this one too (definately > lower, maybe upper). > > On Thursday, I went in for pre-op x-rays and photos. The lady in the > office that handles the insurance wanted to talk to me about how much > I would need to pay. She told me that in their past experience that > even though I was approved by the insurance company (5 weeks ago) for > 70% and I would have to pay 30%, that they tend to only get 50% > payment from them. That means that I would have to pay $7,000. They > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > and the remaining $4,000 would have to be paid out over a year. I > was in shock. I was not expecting that much. I don't have $3,000 > nor can I come up with it in less than two weeks. I left really > upset and frustrated. I don't want to start over later or with > another doc... > > Well, I called the insurance company with the CPT (?) codes and > charges for the surgery. The insuance company said they were well > within the limit of what they consider to be " reasonable and > necessary " and they would pay 70%. I called my doctors office back > and explained to the lady what the company told me. She said she > couldn't believe they said that because that is not what they do.... > Well, I am sorry but I am not going to take her word for it. > > Anyhow, in the end, she talked to my doctor about it and we agreed > that I would pay my 30% which is a $4,000 max. I didn't have any > problems with them last year so I didn't expect any this time, but I > think if I had things to do over again, I would have asked about this > earlier. Hopefully none of you have this problem but please do be > cautious of what your doc's office says... > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Terri, Unfortunately, there are other " in network " doctors in my area. I was just extremely upset that my doctor's staff waited until 2 weeks before surgery to tell me this. I feel like they should have said something right away. I also just did not feel like it was right for them to automatically charge me as my insurance only paying 50% when they don't know for sure either. Well, it sounds like your situation is better. I hope it all works out for you and you do get your $1000 back! Good Luck! I hope your healing is going well! > > I really like my oral surgeon. He did a SARPE last year on me. My > > insurance changed in January and he was then " out of network " on my > > current plan. I like him a lot though and decided it was worth > > paying a little extra to get him to do this one too (definately > > lower, maybe upper). > > > > On Thursday, I went in for pre-op x-rays and photos. The lady in > the > > office that handles the insurance wanted to talk to me about how > much > > I would need to pay. She told me that in their past experience > that > > even though I was approved by the insurance company (5 weeks ago) > for > > 70% and I would have to pay 30%, that they tend to only get 50% > > payment from them. That means that I would have to pay $7,000. > They > > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > > and the remaining $4,000 would have to be paid out over a year. I > > was in shock. I was not expecting that much. I don't have $3,000 > > nor can I come up with it in less than two weeks. I left really > > upset and frustrated. I don't want to start over later or with > > another doc... > > > > Well, I called the insurance company with the CPT (?) codes and > > charges for the surgery. The insuance company said they were well > > within the limit of what they consider to be " reasonable and > > necessary " and they would pay 70%. I called my doctors office back > > and explained to the lady what the company told me. She said she > > couldn't believe they said that because that is not what they > do.... > > Well, I am sorry but I am not going to take her word for it. > > > > Anyhow, in the end, she talked to my doctor about it and we agreed > > that I would pay my 30% which is a $4,000 max. I didn't have any > > problems with them last year so I didn't expect any this time, but > I > > think if I had things to do over again, I would have asked about > this > > earlier. Hopefully none of you have this problem but please do be > > cautious of what your doc's office says... > > > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Terri, Unfortunately, there are other " in network " doctors in my area. I was just extremely upset that my doctor's staff waited until 2 weeks before surgery to tell me this. I feel like they should have said something right away. I also just did not feel like it was right for them to automatically charge me as my insurance only paying 50% when they don't know for sure either. Well, it sounds like your situation is better. I hope it all works out for you and you do get your $1000 back! Good Luck! I hope your healing is going well! > > I really like my oral surgeon. He did a SARPE last year on me. My > > insurance changed in January and he was then " out of network " on my > > current plan. I like him a lot though and decided it was worth > > paying a little extra to get him to do this one too (definately > > lower, maybe upper). > > > > On Thursday, I went in for pre-op x-rays and photos. The lady in > the > > office that handles the insurance wanted to talk to me about how > much > > I would need to pay. She told me that in their past experience > that > > even though I was approved by the insurance company (5 weeks ago) > for > > 70% and I would have to pay 30%, that they tend to only get 50% > > payment from them. That means that I would have to pay $7,000. > They > > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > > and the remaining $4,000 would have to be paid out over a year. I > > was in shock. I was not expecting that much. I don't have $3,000 > > nor can I come up with it in less than two weeks. I left really > > upset and frustrated. I don't want to start over later or with > > another doc... > > > > Well, I called the insurance company with the CPT (?) codes and > > charges for the surgery. The insuance company said they were well > > within the limit of what they consider to be " reasonable and > > necessary " and they would pay 70%. I called my doctors office back > > and explained to the lady what the company told me. She said she > > couldn't believe they said that because that is not what they > do.... > > Well, I am sorry but I am not going to take her word for it. > > > > Anyhow, in the end, she talked to my doctor about it and we agreed > > that I would pay my 30% which is a $4,000 max. I didn't have any > > problems with them last year so I didn't expect any this time, but > I > > think if I had things to do over again, I would have asked about > this > > earlier. Hopefully none of you have this problem but please do be > > cautious of what your doc's office says... > > > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Terri, Unfortunately, there are other " in network " doctors in my area. I was just extremely upset that my doctor's staff waited until 2 weeks before surgery to tell me this. I feel like they should have said something right away. I also just did not feel like it was right for them to automatically charge me as my insurance only paying 50% when they don't know for sure either. Well, it sounds like your situation is better. I hope it all works out for you and you do get your $1000 back! Good Luck! I hope your healing is going well! > > I really like my oral surgeon. He did a SARPE last year on me. My > > insurance changed in January and he was then " out of network " on my > > current plan. I like him a lot though and decided it was worth > > paying a little extra to get him to do this one too (definately > > lower, maybe upper). > > > > On Thursday, I went in for pre-op x-rays and photos. The lady in > the > > office that handles the insurance wanted to talk to me about how > much > > I would need to pay. She told me that in their past experience > that > > even though I was approved by the insurance company (5 weeks ago) > for > > 70% and I would have to pay 30%, that they tend to only get 50% > > payment from them. That means that I would have to pay $7,000. > They > > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > > and the remaining $4,000 would have to be paid out over a year. I > > was in shock. I was not expecting that much. I don't have $3,000 > > nor can I come up with it in less than two weeks. I left really > > upset and frustrated. I don't want to start over later or with > > another doc... > > > > Well, I called the insurance company with the CPT (?) codes and > > charges for the surgery. The insuance company said they were well > > within the limit of what they consider to be " reasonable and > > necessary " and they would pay 70%. I called my doctors office back > > and explained to the lady what the company told me. She said she > > couldn't believe they said that because that is not what they > do.... > > Well, I am sorry but I am not going to take her word for it. > > > > Anyhow, in the end, she talked to my doctor about it and we agreed > > that I would pay my 30% which is a $4,000 max. I didn't have any > > problems with them last year so I didn't expect any this time, but > I > > think if I had things to do over again, I would have asked about > this > > earlier. Hopefully none of you have this problem but please do be > > cautious of what your doc's office says... > > > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Terri, Unfortunately, there are other " in network " doctors in my area. I was just extremely upset that my doctor's staff waited until 2 weeks before surgery to tell me this. I feel like they should have said something right away. I also just did not feel like it was right for them to automatically charge me as my insurance only paying 50% when they don't know for sure either. Well, it sounds like your situation is better. I hope it all works out for you and you do get your $1000 back! Good Luck! I hope your healing is going well! > > I really like my oral surgeon. He did a SARPE last year on me. My > > insurance changed in January and he was then " out of network " on my > > current plan. I like him a lot though and decided it was worth > > paying a little extra to get him to do this one too (definately > > lower, maybe upper). > > > > On Thursday, I went in for pre-op x-rays and photos. The lady in > the > > office that handles the insurance wanted to talk to me about how > much > > I would need to pay. She told me that in their past experience > that > > even though I was approved by the insurance company (5 weeks ago) > for > > 70% and I would have to pay 30%, that they tend to only get 50% > > payment from them. That means that I would have to pay $7,000. > They > > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > > and the remaining $4,000 would have to be paid out over a year. I > > was in shock. I was not expecting that much. I don't have $3,000 > > nor can I come up with it in less than two weeks. I left really > > upset and frustrated. I don't want to start over later or with > > another doc... > > > > Well, I called the insurance company with the CPT (?) codes and > > charges for the surgery. The insuance company said they were well > > within the limit of what they consider to be " reasonable and > > necessary " and they would pay 70%. I called my doctors office back > > and explained to the lady what the company told me. She said she > > couldn't believe they said that because that is not what they > do.... > > Well, I am sorry but I am not going to take her word for it. > > > > Anyhow, in the end, she talked to my doctor about it and we agreed > > that I would pay my 30% which is a $4,000 max. I didn't have any > > problems with them last year so I didn't expect any this time, but > I > > think if I had things to do over again, I would have asked about > this > > earlier. Hopefully none of you have this problem but please do be > > cautious of what your doc's office says... > > > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 And another, Harmony... Get it in writing, from your insurance company. If you have a document to present, you're better off than if you report a verbal conversation. This stuff is so quirky. I'd bet that your surgeon's insurance person knows what will happen, and that you'll need documentation to get the $$$ from the insurance company. They should not mind giving you a name of a person and a statement, if they're playing straight with you. Good wishes. It's difficult to navigate these problems, without more bureaucratic complications. Cammie > I really like my oral surgeon. He did a SARPE last year on me. My > insurance changed in January and he was then " out of network " on my > current plan. I like him a lot though and decided it was worth > paying a little extra to get him to do this one too (definately > lower, maybe upper). > > On Thursday, I went in for pre-op x-rays and photos. The lady in the > office that handles the insurance wanted to talk to me about how much > I would need to pay. She told me that in their past experience that > even though I was approved by the insurance company (5 weeks ago) for > 70% and I would have to pay 30%, that they tend to only get 50% > payment from them. That means that I would have to pay $7,000. They > would need a $3,000 deposit from me prior to my surgery on Oct 2nd > and the remaining $4,000 would have to be paid out over a year. I > was in shock. I was not expecting that much. I don't have $3,000 > nor can I come up with it in less than two weeks. I left really > upset and frustrated. I don't want to start over later or with > another doc... > > Well, I called the insurance company with the CPT (?) codes and > charges for the surgery. The insuance company said they were well > within the limit of what they consider to be " reasonable and > necessary " and they would pay 70%. I called my doctors office back > and explained to the lady what the company told me. She said she > couldn't believe they said that because that is not what they do.... > Well, I am sorry but I am not going to take her word for it. > > Anyhow, in the end, she talked to my doctor about it and we agreed > that I would pay my 30% which is a $4,000 max. I didn't have any > problems with them last year so I didn't expect any this time, but I > think if I had things to do over again, I would have asked about this > earlier. Hopefully none of you have this problem but please do be > cautious of what your doc's office says... > > -Harmony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2002 Report Share Posted September 21, 2002 Oh, guys. Anything can change at any moment. Your insurance company can change, if your employer decides to drop one and substitute another. The coverage can change. You can change jobs, and insurance companies. That pre-approval is no guarantee. It's helpful, but you gotta stay on top of this. I say the above not because I had any troubles at all. My own insurance company has been wonderful. But others have had nightmares about what would be covered and what would not. Just read your policies, seek help from your doc's insurance specialists, and be prepared to fight if you must. Many folks have, and many folks have won approval after several denials. Cammie > I had a similar situation with my surgery. My orthodontist > recommended a surgeon to me, unfortunately he was " out of network " so > I would have to pay 20% of the costs. All of the oral surgeons in my > area who were in the network had very little experience doing major > corrective jaw surgery. Anyway, I had two surgeries done with my " out > of network " doctor and I have never had any trouble with the billing. > As fas as I know, the insurance company can't suddenly change their > policy after they approve the procedure. They told me they would pay > 80% and that is exactly what they did. I agree with you, the woman in > the office was probably incorrect. I expect that you'll have no > trouble at all and you'll only have to pay 30%. > > - Quote Link to comment Share on other sites More sharing options...
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