Good news and BAD news :/

Message

#1 Post by **HokieTay** » Wed Jun 03, 2009 4:42 pm

So today I went in for my final stuff with my surgeon before the big surgery (Le Forte I and BSSO) on June 15.

Good news: After haggling back and forth with my insurance company saying they didn't do pretreatment estimates or preauthorizations, they got the letter saying they'd cover it today! It was so annoying b/c I switched surgeons, but they had already approved it with another surgeon.

Other good news, I am ready to go for june 15. I really think this is going to happen. I got my molds, new pictures, and stuff made for my splint. He also sedated me so he could get an exact idea of how he wants the jaws.

BAD NEWS: We sat down to discuss final things with the office mgr right before. Now they were in network, but went out of network on April 16. Really annoying b/c I started seeing them before they went out of network. However, I knew this so whatever... I am responsible for 30% out of pocket instead of 15%. But then she is like and the cost for EVERYTHING is $15,810. Again, not bad... what I was expecting, but then she tells me AND YEAH YOU HAVE TO PAY THAT ALL UP FRONT BEFORE THE SURGERY.

Umm what?! This was never relayed to me before. I was told they'd "work with me" and yadda yadda. I am 24 years old and my parents cannot afford to help me with this. My dad accompanied me on this appt too since I was going to be sedated. I had kept some stuff from him (like the fact that they were out of network) b/c I didn't want him to worry about the cost. So I straight up tell her umm, I can't pay that all right now. She said the reason it's like that is b/c Blue Cross Blue Shield won't pay them and that the insurance company will reimburse me. Well fine, but can't i put a deposit?! She said yes. But then she is pushing me to just put it all on Care Credit. That's all fine and dandy except then I feel like I have no leverage with them. You know, they will have their money and if something goes wrong with BCBS the doctor's office won't be fighting for me.

So, they put some of the pre-op stuff on care credit today, but now I am thinking I am going to call her tomorrow and tell her just to charge 20%. My dad thinks that's a better idea too b/c he doesn't like them having 16k and then wiping their hands. I guess while I was under he kind of told the office staff how he thought they blind sided me too. So he said he will stay out of it unless she gives me trouble tomorrow.

Sorry, very long winded... but ANY ADVICE?!

#2 Post by **joey3001** » Wed Jun 03, 2009 5:06 pm

yeah, that sounds a little fishy, did you're previous surgeon say it would have to be paid up front as well?

#3 Post by PJ » Wed Jun 03, 2009 5:47 pm

I feel your pain. I had a similar issue, in that Carefirst would not give a pre-approval because they claimed they would need the surgical notes in order to determine whether the surgery was considered "experimental or cosmetic." What a bunch of crap. Anyway, my surgeon's office also insisted on payment up front--it was also about $15,000. Long and short--the insurance company did end up covering 80%, BUT that was after they did the reduction of charges that all insurance companies do--which, apparently, my surgeon's office doesn't accept. So--I did get reimbursed about $6,000 from the insurance company, but still had to lose about $9,000 out of pocket. I am not happy with the way the surgeon's office handled this, but what can I do. The insurance company did their part. I hope things work out better for you.

#4 Post by PJ » Wed Jun 03, 2009 5:50 pm

P.S. Pray that the hospital fee is covered 100%--mine was, thank God! The cost for one night in the hospital was $34,000!!!!

#5 Post by **HokieTay** » Wed Jun 03, 2009 6:03 pm

Well, I am on my fourth surgeon!! The first one I can't say really counts because that was like 10 yrs ago when I was a kid and didn't want to do it (whatta regret)! Another one was in network so no, nothing up front, but I DID NOT feel comfortable with him so that's why I came to this surgeon. Before the one I wasn't comfortable with I saw another one. Ridic. consultation fee which I did not get back. You had to put 50% down, which was half of $16,851! Furthermore they were like oh and this amount is subject to increase or decrease without conditions. They also didn't do pre-approvals and pre-auth stuff. They see a lot of people and are very well known in the Northern VA/DC area so I guess they can stuff it to you.

I am just a little disappointed b/c his office staff lady led me to believe they'd work with me. Now, don't get me wrong... they're not like give us $15,800 or we're not doing it, but still. I feel like she reeled me in and then now she is like BAM! The surgeon has nothing to do with this and I like him. The surgery is in 12 days so there is not much I can do now. I just feel bad b/c my mom and dad are so mad and they're talking about leveraging things to help me pay for it and this is EXACTLY WHAT I DIDN'T WANT. I do not want them to have to help. It is making me so upset to think they will have to pay for some of this.

I am going to call her tomorrow though and say look, it's fine to charge yesterday's fees ($1200) to the care credit, but as far as the rest of the $14,400 I'd like you to charge only 20% of that like we discussed. My dad said he is calling if she has a problem with that.

#6 Post by **HokieTay** » Wed Jun 03, 2009 6:05 pm

PJ wrote:P.S. Pray that the hospital fee is covered 100%--mine was, thank God! The cost for one night in the hospital was $34,000!!!!

No, no my hospital is in network and I only have to pay a $200 or $300 copay as long as it is pre-certified, which it will be. Haha, that is the saving grace. $34K?!??! Wow, I was thinking like $20k for the one day/night I will be there.

#7 Post by **chicago29** » Wed Jun 03, 2009 6:08 pm

The only advice I can give is that EVERYTHING is negotiable. You should be able to get at least a 15% to 20% discount.

Also, another tactic is to find out what insurance plans they DO accept, and see if you can find out what procedure codes you are having performed (ask the OS or the treatment coordinator), and then see if you can somehow find out how much that insurance company pays for those procedures. Yes, this is a lot of work, but if you were successful you'd know exactly how much they get paid by an insurance plan. You can use that to try to negotiate the final price.

That's also a very good idea about the hospital - you need to ensure the hospital and anaesthesiologist are covered by insurance as that can be a huge portion.

Also PJ...$34,000 for ONE night in the hospital??? That is INSANELY high!!! I spent two nights in the hospital and they charged only $19,200. And insurance paid them a helluva lot less than that

#8 Post by **charlsie142** » Wed Jun 03, 2009 6:25 pm

Hokie-
I'm so glad I read your post. I just received a copy of the letter that was sent to my insurance for preauthorization and they also told me that since my insurance is out of network, I have to pay 50% down to even SCHEDULE my surgery (Lefort I, possibly BSSO) and then the remaining 50% 2 weeks prior to my surgery. I had no idea this was going to happen...so now it's the waiting game to see what my insurance will cover (and what I can hopefully get reimbursed after the surgery). I'm like you though, 25 years old and wanting to be financially independent from my parents, but I'm a grad student and so may be asking my parents for help as well.

At least this info has been given to me about 6 months before my surgery is predicted...I can't imagine the shock you and your family have had! Keep us updated if you are able to negotiate anything, and of course, let us know how your surgery goes. Here's wishing you a quick and painless recovery!

#9 Post by **HokieTay** » Wed Jun 03, 2009 7:07 pm

Yes, my hospital is in network and I believe a preferred provider so no matter what all I have to pay is $200 on that.

I know... I feel anything is negotiable too. But when she was going over it today it didn't seem like she was willing to budge on the price. Finding out what participating insurance companies would pay them is a GREAT IDEA though. I used to have Cigna and they take Cigna so maybe I will call Cigna tomorrow and see what the deal is.

And then, depending on what they say, maybe I can negotiate 10-15% off the $15,810.

#10 Post by PJ » Wed Jun 03, 2009 8:38 pm

Yeah, $34K was insane!! I was originally told by the surgeon's office that the hospital bill would likely be $23K. I have no idea why the cost was so high, but I did not question it because I didn't have to pay a dime. Weird thing is that the insurance paid all of it--there was no reduction of charges. Go figure.

#11 Post by PJ » Wed Jun 03, 2009 8:42 pm

Charlsie142--just curious--by any chance are you in Charlotte? Univ. Oral Surgeons there also asked 50% down and the rest just before surgery. I live in MD but had my surgery done down there--Dr. Farrell was awesome. I'm just not happy with the payment thing.

#12 Post by **charlsie142** » Thu Jun 04, 2009 8:31 am

PJ- yep, Dr. Farrell (Brian) is who I'm hoping will perform my surgery. Small world, huh?

#13 Post by PJ » Thu Jun 04, 2009 1:07 pm

Wow! Yep, it is a small world. Well, I am only 6 weeks or so, post op, but I have had no real issues as of yet. I think he did an awesome job, he has a great reputation, and he was trained by the best, so I think you'll be happy to know you are in excellent hands. I found that my experience has been significantly better than a lot of folks on here, and I credit that to Dr. Farrell.
Let me know how you do!

#14 Post by **HokieTay** » Thu Jun 04, 2009 4:05 pm

Well good news... of the $15,810 they're only making me put down $4,000 for the day of the actual surgery. And that includes the stuff I got done yesterday. Now hopefully my dental kicks in and pays some of those molds, splints, etc.

#15 Post by **charlsie142** » Fri Jun 05, 2009 7:23 am

Great news, HokieTay!

How'd you manage that, if you don't mind me asking?