Paying for surgery when doctors don't accept insurance

[Guest guest]

Dolly asked about how one handles having a procedure when your doctor does not

accept insurance. Important question and I first want to clarify something that

I wish I had known earlier on.

IF you have a plan that covers (partially) your seeing a doctor who is

out-of-plan, that also includes doctors who do not accept any insurance.

Accepting insurance means that the doctor accepts whatever the insurance is

willing to pay as full coverages. But any doctor's expenses will be partially

covered by coverage that allows you to go out-of-plan.

I was fortunate that my discomfort was mild enough to allow me to research my

options, and change insurance plans (which is only allowed to happen once a

year; at a set time). My government job gave me about 7 different insurance

companies to choose from. I spent months (YES, months!) looking into them and

talking to the office of the doctor that I was planning on having perform my

surgery. I asked the woman who handles his insurance claims " Which plan tends

to pay the best? " and she knew. In my case, in NYC, it was GHI with a

catastrophic-benefits rider, although it is still unclear to me how much extra

that rider helped. The insurance companies are extremely unhelpful in

predicting how much they are likely to pay and they cannot promise, they can

only guess.

I had my surgery with Dr. West. His office handled all the details with the

insurance company. Starting with getting the pre-approval. I needed to pay

$2,000 upfront, with the clear understanding that I was responsible for paying

anything that the insurance did not cover. Once the insurance kicked in, and

paid about $8,300, I was responsible for the rest.

Yes, his fee his high. Then again, my surgery took a long time (I think it was

4 hours; I don't remember anymore). Over 40 fibroids. I don't think there are

many doctors around who could have done a myomectomy on that many fibroids. And

I think that some who could have done it, would still have chosen to switch to a

hysterectomy and told me it was medically necessary. So it was well worth the

$3,750 that I paid myself, to be certain that I would wake up with my uterus

still inside me.

Especially after what I learned at the HERS conference last weekend, which I

still intend to post about.

R.