Surgery Covered for Dr. Gunson in Santa Barbara, CA?

[dayeangphurr]

Has anyone had their insurance cover their surgery for Dr. Gunson in Santa Barbara, California? And if yes, what insurance company do you have? I'm under Blue Shield by my parents and would like to consider Dr. Gunson for the operation. Thanks a bunch!

[Marisama]

Good question. I need to know the same thing.

[chicago29]

There are several people on this board that have had their surgery through him so hopefully they will chime in with their experience. I heard (and it could just be speculation) that Gunson/Arnett are not in any insurance network, which means you're going to have have a lot to pay out of pocket. I believe the same goes for Wolford in Texas.

In other words, the "rock stars" stay out of insurance network so they can charge hefty surgical fees.

[cvn]

Anthem covered part of mine and I had to pay the difference. They covered the hospital stay 100% and about 15% of the surgeon's fee.

[ColoradoGirl]

Yep, Chicago's right: they're not in any network, and you will pay at least something out of pocket.

My insurance has guaranteed to cover "up to 80%" but wouldn't disclose how much until after the surgery, so I still don't know how much I'll end up paying (argh). My hospital stay and the anesthesiologist were covered, but since I live in SB they're both in-network for me.

[Marisama]

Do you know how much the hospital and anesthesiologist's fees were just in case my insurance doesn't cover it?

[cvn]

Hospital fee for surgery and two nights stay was 106k (almost lost my lunch when I opened that envelope) and I think the anesthesiologist was like 4k or so. Anthem paid for all of both of those, for which i am grateful.

[Marisama]

106K? I am traveling from out of state and these most likely will not be in-network. I do have an indemnity ppo plan. I think this means I have freedom to choose a surgeon and location. Not entirely sure though.

[cvn]

Yeah I just looked it up. Anesthesia was $5,400 and hospital was 106,451.23, which really did almost make me have a coronary until I figured out how to read the statement. I think they covered 18k of the surgeon's fees. I'm having trouble getting them to pay the assistant surgeon's fees. I should call again about that on Monday....

[qwertz1]

hospital was 106,451.23

jeeez...

I'm considering a very expensive surgeon, the most expensive surgeon I know over here (western europe).

he happens to work in a luxury hospital which prides itself to also be a 4-star-hotel at the same time.
price tag for hospital stay and operating room? about 10,000.

[ColoradoGirl]

Yep, gotta love American healthcare. Most of the dough, of course, goes to the insurance companies.

[dayeangphurr]

cvn,

Do you have HMO or PPO? Or what plan do you have?

[qwertz1]

Yep, gotta love American healthcare. Most of the dough, of course, goes to the insurance companies.

the mentioned hospital is completely private btw, it doesnt receive any taxpayer funding, and is turning a profit.
how can you even spend 100k in 3 days...

[cvn]

That's just sort of how hospital bills have always worked in the US, in my experience. You're paying for all the people who didn't pay their bills. Every time I've had this surgery, the hospital bill was over 100k. And yes that hospital is private, but it's the only one those surgeons use so not much of a choice there. On the bright side I had a private room and they were way nicer staff than I've ever had in any of the other hospitals. Even in a public hospital though, they'll send you bills like that to try and cover some of their missing expenses. It's why the insurance negotiates the bill down internally.

I was on PPO. I haven't done the final math, which I'll do for my taxes (ew), but I'm guessing I'm out of pocket about 70k, which is mostly surgeons fees, housing, and meds. For a typical surgery not involving a messy redo and with anthem/bc/bs, I'd wildly guess that out of pocket with these surgeons would be less than half of that, but of course you'd get better numbers by asking Arnett and Gunson's insurance guru as it's different for everyone.

Basically it's important to have all your financial ducks in a row before any big expense. This is no different.

[Marisama]

Ok, so yours was more expensive because it was a redo? I was starting to feel like surgery with Gunson was going to be out of reach. Thanks for clearing that up.