Just got the copy of the bill to my insurance for the MVD and holy mole $74,000
Not sure how much I'll owe out of that.
!
I've heard of numbers higher than $100K from some patients. MVD is certainly not cheap when all elements of the procedure are accounted for. Likewise, however, I'd advise that you ask the hospital for a more detailed accounting of the content of the several "hospital services" entries in your form. At least in your case, insurance has indicated the availability of "coinsurance".
OMGoodness!!!
That’s insane!
Mine was 50k. We paid 500 dollars… But insurance premiums keep getting higher
My doctor bill alone was $127000. My insurance is saying only $4800. of it is applicable towards my $6000" out of network" deductible, so I am responsible for the balance. I have appealed, but it was denied. Not sure what the next step is, but would love to hear from anyone who has some advice!
Christine, Do I correctly read that your insurance company is declaring you are responsible for over $120K in expenses? That's simply nuts. Go talk with an attorney about whether you have grounds to sue the insurance folks.
Regards, Red
Yes Red, that is what my explanation of benefits says.the surgeon was out of network, but I do have out of network benefits, and the surgery was pre certified. My policy states that I have a $6000.00 deductible for out of network , with my out of pocket maximum being $7000. The doctors billing company called me to ask me to appeal, as they were not paid anything since the deductible was not met. I did appeal, and it was denied. Funny thing is the hospital and anesthesiologist were in network, and they have been paid. I think I will take your advice and contact an attorney.
Thanks for your input !
Red that is correct!! I have BC/BS, and was told that the hospital I had my MVD at was covered 100% and in network, but the Neurosurgeon was not in network. I received a statement saying I had a balance due to the Doctor of $167,000.00. I spoke to the insurance company and they said that when you go out of "contract" or policy, you are not using your policy "so to speak" and technically , even though you have a deductible and a certain allowance/max, you could be responsible for that amount, and if the doctor wanted to be a real ass, he could potentially put a lein on your house or income. I am lucky in that my Doctor does not "balance bill" meaning he writes off whatever the balance is and does not bankrupt the person having surgery.
The out of network maximum is just based on what insurance will pay, if you get my drift, not what the doctor is billing or wants. The doctors that are out of network can really charge whatever they want, which is why so many of the really good ones arent in Network. Anything that insurance wont cover is really the patients problem. This was one of my gripes about the overhaul and "Obamacare" is that none of this was addressed. If you remember I work for an insurance company as well, and even I was not aware of this "clause" in the policy but it is in there. I could tell you horror stories on the automotive end of people being sued, even with tons of coverage and having leins on their houses.
The insurance lobby is the largest group of lobbiests in the US after the Oil companies, they can do whatever they please
Wendy "crashgirl"
Richard A. "Red" Lawhern said:
Christine, Do I correctly read that your insurance company is declaring you are responsible for over $120K in expenses? That's simply nuts. Go talk with an attorney about whether you have grounds to sue the insurance folks.
Regards, Red
By the way, the $167,000.00 was only the surgeons fee, that did not include anyone else. My insurance has pain about 10K of that, and after speaking to the surgeons office, they are also appealing for more.
I would like to see what was paid to the hospital, I never recieved a statement for that , for the surgery or ICU, but I am thinking my surgery was billed around 500k, not that , that is what they will get in total
Wendy
I am not being billed for it, but thanks....I am lucky that my neurosurgeon is writing it off...I think alot of times its a negotiating starting point, they bill high, to get what they want, and the real price is somewhere in the middle. It a game play, but if you aren't insurance savvy
, you can have a heart attack just opening the mail!
Wendy
Hey Wendy, as you may recall , we have the same surgeon, and apparently the same insurance deal! My appeal was denied, and was a bit worried about my portion of the bill. Hearing your result gives me hope , especially since I want to have MVD on the other side. FYI, my two days in ICU were $52000., anesthesia $9000., and assorted other fees are at $10000. and counting!
I forgot, so sorry!! Yeah, you arent going to get slammed with the difference, I bet I just got the same paperwork...I have a form, to fill out saying that I am letting the doctor file a grievance for the unpaid balance.
If I remember correctly, there was a panphlet (sic) that they gave me that said no patient would be bankrupted by his care. Have you spoken to his office staff in the accounting dept? They have been awesome with me, I talk to Marcus there.
Christine said:
Hey Wendy, as you may recall , we have the same surgeon, and apparently the same insurance deal! My appeal was denied, and was a bit worried about my portion of the bill. Hearing your result gives me hope , especially since I want to have MVD on the other side. FYI, my two days in ICU were $52000., anesthesia $9000., and assorted other fees are at $10000. and counting!
Hah, I remember the same paperwork, and I have spoken with Marcus too! I just got the appeal denial Friday, so I will have to give Marcus a call.
Insurance checks are always cut to the owner of the policy, not to the patient (if different). The policy owner has paid the premiums or had them paid on his or her behalf by an employer.
Regards, Red
shindig said:
Do you guys give the medical people access to your records? I got a letter from the anesthesiologist asking for my signature to give them access to my medical records to use in their appeal for more money...
The other thing is my girlfriend got a check for the anesthesiologist made out to her for $3600. The anesthesiologist had sent a letter right after the surgery saying the insurance would send a check and to pay him when it comes...
I'd just ignored the letters but the check came last week. Just seems weird my gf got the check when I had surgery, though I'm on her insurance.
I have paid $2200 for my MVD surgery. Total was about $50,000.
Red, if they are in network they are paid directly, if they are out of network, then the person getting the treatment(insured) gets the check. Thats part of the agreement doctors have and safeguard they get when they become in Network.
The reason they are paid directly in Network, is that the doctor signs an agreement with xyz insurance company to accept their rates. If they are out of Network they can charge whatever, therefore the owner of the policy is paid in case there is a dispute.
Insurance laws vary from state to state, so some may be different, but that the way most of them work
Wendy
Richard A. "Red" Lawhern said:
Insurance checks are always cut to the owner of the policy, not to the patient (if different). The policy owner has paid the premiums or had them paid on his or her behalf by an employer.
Regards, Red
shindig said:Do you guys give the medical people access to your records? I got a letter from the anesthesiologist asking for my signature to give them access to my medical records to use in their appeal for more money...
The other thing is my girlfriend got a check for the anesthesiologist made out to her for $3600. The anesthesiologist had sent a letter right after the surgery saying the insurance would send a check and to pay him when it comes...
I'd just ignored the letters but the check came last week. Just seems weird my gf got the check when I had surgery, though I'm on her insurance.
If her name is primary on the policy, then the check would be in her name. The check you got can be signed over to the anesthesiologist. If you are on BC/BS then anyone who is out of network will not be paid directly and you will end up getting the checks.
I also got an appeal form, but only to sign that the doctor has my permission to go to arbitration in relation to amount paid, I dont know why they would ask for access to your medical records since they would already have them
Wendy
shindig said:
Do you guys give the medical people access to your records? I got a letter from the anesthesiologist asking for my signature to give them access to my medical records to use in their appeal for more money...
The other thing is my girlfriend got a check for the anesthesiologist made out to her for $3600. The anesthesiologist had sent a letter right after the surgery saying the insurance would send a check and to pay him when it comes...
I'd just ignored the letters but the check came last week. Just seems weird my gf got the check when I had surgery, though I'm on her insurance.
You got a bargain.
Oh my gosh!!! I had no idea it was this much.