I got this packet of paper today from the insurance company. I probably should have gotten this BEFORE I started the whole process. I hardly understand this insurance thing. I did find out; however, that my doctor is out of network. The closest
facility to me is in Durham. It's funny how there are no
facilities in Raleigh, NC. I really don't want to go to Durham. I really want to stay with this doctor, but of course, more money is involved. I really don't know how to read this summary of benefits. I'm pretty alone in this situation, and my parents won't explain anything to me. So, I decided to scan the benefits sheet. I cropped it so it just showed the benefits.
I'm not sure if I pay $2,500 or $3,700 for the surgery. What is coinsurance? This is my primary insurance, and I don't have a secondary one.
I'm starting to think that March is too early for my surgery. I am thinking late May or early June. I am fine with this. I can save more money and more vacation time from work. On a side note, I think it's funny that they chose Yahoo maps to determine mileage, lol.
All is well with me. Work was super easy. I work tomorrow, and I'm off Monday. :)
OK...here you go...and I know his because my insurance just changed on Jan 1 and I am now in a situation similar to yours. You will pay the deductible and then after that, you will pay 50% of the rest of the balance until you hit $3700 at which point your insurance covers the rest. So, basically, you gotta be prepared to pay $3700. You may get away with less, but that will depend on what your surgeon actually charges. You should have a negotiated rate that is determined by your insurance company but that the surgeon's office can tell you. With that, you can figure out what you'd actually be billed.
ReplyDeleteCoinsurance is another name for copays. It's the part YOU cover.
You might be able to use the surgeon in Raleigh to save all that money but still use the surgeon in Durham for the fills and after care. Just a thought...
I don't even make $3700 a month! lol If I do decide to get the surgery in Durham, would it be possible to get all of my pre-op results sent to that surgeon, or would I have to do them all over again? Because paying $450 sounds alot better than $2500, lol. And I wouldn't mind dealing with the travel.
ReplyDeleteAmanda, you have a right to get copies of all your pre-op results (whether they'll send them or you need to pick them up is up to the docs). I would also check with the Durham doc early on to see if you've got all the pre-op's that he/she requires covered (even with the three hospitals I looked at here they had some of the same pre-op requirements, but each one required different things as well...ie. I had to have a heart MRI, but no gastro-scope, which another one required). I'd also check to make sure the costs aren't just the surgeon's costs...as the facility can also charge a separate hefty fee, especially if you stay overnight. Good Luck!
ReplyDeleteYeah, BG is right, all your pre-op stuff that you've done is done no matter who does the surgery. Another surgeon may require more tests but what you've done already will be good for whoever the surgeon is. You can have the results sent to the other surgeon. I would also recommend that you keep copies of the results for yourself. It seems to me that a lot of things get lost once things are submitted to the insurance companies. I have everything I've done in my own little handy dandy folder and it's come in handy so far. At one point I went in for a monthly check in and they asked for results from test x. I gave it to them. Next month, same thing. I learned that little trick back in the Navy...no one takes care of your file better than YOU.
ReplyDeleteAmanda - I'm sorry for your delay, but maybe it will turn out that we get banded around the same time. : )
ReplyDelete