Wellness

[Laura14]

@ScrapHappy I am very sorry you deal with this on a constant basis. It's beyond frustrating.

[SouthernBee]

@Laura14 : Please run from this office and doctor now. Find another doctor and schedule later.Hopefully  this is something that can be delayed. You need time to rest from this unnecessary stress and anxiety.🤗🙏

[Laura14]

@SouthernBee I already have my sneakers on. 

FINALE:

I called around today and did the scheduler's job trying to figure out the surgery expenses by calling all over the place with my CPT codes and insurance information.

Apparently I don't get out much.

I thought this whole sinus surgery would be around $10-15,000 all together that my insurer and I would be sharing.

Try close to $30,000, and you get, conservatively, the entire amount this practice stood to gain from me having the surgery with them. And that's just the doctor, outpatient facility, and anesthesia. 

Does NOT include any pre-op or post-op visits that naturally come with or the pathologist he wants involved to culter the sinus infection or the alcohol I would need after receiving the final bill or the heart attack fees that I would incur after paying the final amount, or the street walker clothes I would need to walk the corner to get the money to pay off those bills, etc, etc, etc.

Had they ran the numbers on day one, which they could and should have, I would have saved myself and them a ton of stress and work that the scheduler never wanted to do anyway.

Why did they not do this as a first step before wasting the hospital's time and calendar space, my time, their time, insurance reps time...?

No wonder our healthcare costs are ridiculous. I found two months worth of payroll that they could have saved had they just been upfront with the price tag.

You have CPT codes from day one. My surgery scheduler should have ran the numbers like the instruction sheet said she would and gotten rid of me on the first day.    

I can not tell you, once again, how appreciative I am of this forum and the people on it. But for you guys, my forays into new experiences like this one would be more miserable and confusing than they already are.

Thank you all for sharing your insights and experience with me. I appreciate it more than you will ever know.  

[Carmie]

@Laura14   it sounds like this doctor does not participate with your insurance.  I can think of no other reason why they would not know how much they're going to get paid for each cpt code.

Even non participating doctor know how much insurance companies allow for each procedure.  Your insurance benefits would determine how much is your cost out of pocket

Example....

Surgery 10,000

Insurance allows 8,000

if the provider is in net work, you might owe  20% of $8,000

if not in network,you owe $2000

Your doctor's office is giving you the run around.  Is the scheduler new?  This is basic information and is not difficult.  Something is off if the doctor's office is not providing you with this info.  I personally could look it up on their computer for them.

[Laura14]

@Carmie Everyone is in network except the anesthesiologists (explain that one to me?) and I don't think I can do sinus surgery awake. Unfortunately, you bleed too badly with the alcohol stupor I would probably prefer. 

My out of pocket max is $8150 and the hospital fees alone are more than that even after I gave them my insurance and pointed that out.

I am not an insurance person and I'm not driving myself nuts to figure it all out when this is not my job for this very reason. She should have done it, compiled it, and explained it.

It doesn't matter since I'm not paying my out of pocket max for a sinus surgery. I'd rather put up with it until I have a new plan or hit the lotto.  

This is all a racket and, as tired as I am of being in the have not group, I'm not throwing over one third of my annual salary at a non life-threatening problem.  

[SouthernBee]

@Laura14 : Thank goodness. Good bye.😃

The last test that I had the doctor's office scheduled everything and verified no copays or extra cost for me. Morning of test registration at the hospital they verified total cost and everything covered by my insurance. Same thing for my last surgery.

When I read everything that you were dealing with just so unnecessary. Like you were trapped in " The Twilight Zone."

My thoughts and prayers will be with you for a better Doctor with staff that know how to to what's necessary and willing to make everything easier for you. Plus speedy recovery and less money from your purse.🤗❤🙏

[ScrapHappy]

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@Laura14 wrote:

@ScrapHappy I am very sorry you deal with this on a constant basis. It's beyond frustrating.

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Thank you.  It's $150 more for me out of pocket and not using insurance.  But I lean towards thinking it will save me some saniety and grief not having to call/follow up all the time.  My insurance company denied MRI this time because they said I don't have a family hixtory or dense breast tissue.  I was surprised to hear that since I have both.  Hate dealing with insurance companies.

[Laura14]

@ScrapHappy Amen. I agree it's worth the money to keep your blood pressure low. I've done the same thing. My worst horror stories are of mammography centers and how they treat us. Big hug!

[Carmie]

@Laura14   if your doctor is in network, you should be livid!  I know I would be.  You can write to PROVIDER RELATIONS  with your insurance co and I would complain to the doctor. Patients do not get involved with procedure codes.

It is not unusual for anesthesiologists  to be out if network when the surgeon is.  When the insurance pays the claim, you will probably be responsible for a balance.  At that time, write a letter of appeal to the appeals address on the Explanation of Benefits

( EOB) statement and tell them you had no choice.....the anesthesiologist  was assigned to you and you had no choice in the matter.  This is called an invisible or ghost provider.

 About 99% of the time, the insurance co will pay the difference.  You must appeal in writing in a timely fashion.

If you need help @ me and I can tell you how to handle it.  I worked in CS for a health insurance co for 25 years.  

[Laura14]

@Carmie You made me cry over here. 🥲 Thank you so much for your kindness. 

In one post, you explained something only a pro would know and showed more courtesy and care towards a complete stranger than the provider whose staff has actually met me and wants me to pay five figures for their "services." 🙏

Thank you! I will definitely add this insurance code nonsense to my goodbye.

Thank you for making me feel like I matter again over here and taking the time to help me. I haven't felt actual sincerity in this whole entire experience until now.