Surgery Costs, Surgeon's Fee, Insurance Coverage/Reimburseme

[Bluejay]

These questions are really meant for US patients. Feel free to comment with experiences in other countries, just please make it clear in your post.

What is your experience?

Did you have to pay anything upfront?

How much did your insurance cover (percent is fine)?

Was the surgeon's fee paid for by insurance?

For my 1st surgery in 2008, The hospital was covered 100% after a $1500.00 deductible. (try and find a plan like that today)
The surgeon was out of network. The insurance company valued his services @ $863.00, which did not come close to the $1500.00 out of network deductible. I was responsible for the $5,000.00 surgeon's fee.

[boodles8]

What is your experience? I started out with BCBS when I began the process and was told it was a covered service; hospital and surgeon were in network, so after the deductible I was supposed to be golden. Midway, my plan changed to United Healthcare. AND it was really through my employer, not truly United, United just administered the employer's plan. Orthognathic surgery was not covered AT ALL under their plan unless you got your face smashed. I appealed, and they still wouldn't cover it. I ended up just doing it and thinking I'd be self pay. The hospital and surgeon were still in network, and they did bill the insurance for everything before they sent me a bill. Go figure, but the insurance paid every cent even though they had denied the claim beforehand!

Did you have to pay anything upfront? Nothing truly upfront. I had to pay for the consult, way back before braces as I was deciding whether to do this. I've also had to pay for any X-rays as I've gone along because the insurance doesn't cover those, and they are not included in the surgeon's fees. Both of these have been billed after the fact.

How much did your insurance cover (percent is fine)? 100% but only because I had had a really bad year healthwise already. Normally I have $5000 deductible, and after that's met 20% coinsurance until some point (forget where) before they'll pay 100%.

Was the surgeon's fee paid for by insurance? Yes. See last question.

[Alicia110613]

What is your experience?
I have BCBS and they approved the procedure. The surgeon and hospital are all in-network and are covered at 100%

Did you have to pay anything upfront?
Not really, except for consultation and other pre-surgery dr visits. I have a $500 deductible.

How much did your insurance cover (percent is fine)?
100% (except for the $500 deductible) at the in-network rate. However, my surgeon used an out of network surgical assistant and the insurance only paid a small portion of that bill, leaving me a balance of about $1k. I was told that the surgical assistant will not balance-bill me and I haven't receive a bill yet -- so we'll see.

Was the surgeon's fee paid for by insurance?
Yes.

[ivonne]

As far as I know Kaiser covers 100% of the surgery... or maybe you need to pay the maximum out of pocket before they
start to pay which is about 2K only.
Check Kaiser's website
I know they do handle this type of surgery and kaiser Oakland has one of the best Maxillofacial departments in the country.

[sirwired]

My bill: (For a LeFort I w/ overnight stay.)

The "rack" rate for everything was about $30,000. That includes the surgeon, hospital, anesthesia, and pre-surgical consults.
Of that, the surgeon's fee was $4,750.

The rate after insurance discounts was $18,250. Of that, the surgeon's fee was $3,400. The real killer was the bill for the hospital... that surprised me last year when I also had a surgery w/ an overnight stay.

The operation was done at a teaching hospital (UNC-CH), and the surgeon was on the faculty at the UNC Dental School; both rack and post-insurance rates are usually (but not always) higher at academic institutions, even ones owned by the state.

For my plan, out of pocket was about $1,200, but of course that varies widely. I switched to a particular plan choice last year (an HMO-like "Exclusive Provider Organization") specifically to obtain better payment for this surgery.

[batwing]

I had a one piece Le Fort I osteotomy with an overnight stay. My stay was coded as outpatient because it was listed as 23 hours, but my surgeon was late on making his rounds and I actually left after like 28 hours... but they still went with outpatient in the claim. I had the following fees (rounded):

Hospital stay: $25,000
Primary surgeon: $7500
Assistant surgeon: $1600
Anesthesiologist: $1500
Preliminary X-Rays: $150
Follow up X-Rays: $150

I had a baby nine weeks before my surgery, and had already met my out of pocket maximum. I have UHC and I have one remaining claim left, and that is the $7500 primary surgeon's fees. Everything else was covered 100% (I had to do a pre approval letter last year, as this is an excluded surgery from my plan.) Before surgery, I gave my primary surgeon a $3000 deposit. Once my claim is completed, assuming they still cover it (they said they would, so hopefully they don't go back on it), I will get that $3000 back.