Metal Mouth Message Board

I was so excited a few days ago, I finally received my authorization for surgery. I will be having a segmented Le Fort I. All was well until I met with my surgeon yesterday. We're finally finalizing everything, and before I go in to meet the surgeon, the office manager says to me by the way, your insurance doesn't cover everything, and your out of pocket expenses will be $7500. I was totally surprised ; I expected to have out of pocket expenses, but nothing like this. I do have health insurance, and according to them (Blue Shield), the procedure has been authorized and I am responsible only for my copayment of $100. Does $7500 sound right to you? I mean, I know that there are things that the insurance won't cover, ie. splints, but what else can cost so much. By the way, the office manager said that the surgeon would give me a break down, but when I asked him, he told me he really didn't know, and that "we" should speak with his office manager. When I pushed about the expenses he said, well you're a complicated case; it's going to be a lot of work, but didn't give me a figure or a breakdown. What can I do?

mgigi,

That's sounds quite high for a covered procedure. Perhaps call Blue Cross and ask what exactly they don't cover. It will make it easier for you to discuss with the OS's office when you get the breakdown from them. I always like a fax or something in writing.

I know all insurances are different, but I only paid my co-pay.

Lo

Hmmm, are you certain that you are using an "in-network" surgeon. I have BC/BS and they paid all but my co-pay and deductible for an in-network surgeon, for an out of net-work surgeon my cost would have been far greater. Depending on where you live though, $7,500 seems like it would be most of the surgeons cost. I drove about 75 miles to get an in-network surgeon for my surgery, well worth it for the money I saved!

What is your co-insurance? When I am ready for surgery, I already know I will have to pay at least that much because my coinsurance is 30% for an in-network doctor.

Thanks for all of the replies. Smile 2006, I am definitely using an in-network doctor; my insurance sent me to his office, and by the way my co-pay should be $50 if it's outpatient, and $100 if it's inpatient. Meryaten, I too was told that the model surgery would not be covered, but should that be costing $7500? Also, even though I do have a few crowns and a bridge, these are all on my lower teeth. I will be having surgery on my upper jaw, and the surgeon mentioned that he "may" have to shave two of my crowns in order to "perfect" my bite. Lastly, Lo, I have already called Blue Shield, but no one has been able to answer any of my questions; I finally decided to send them an e-mail, and it will take at least two days for a reply. Thanks again for the replies. I hope all is sorted soon.