I'm getting surgery next month, but have not scheduled it yet. My doctor works at 2 different places: the hospital and the surgery center. They were able to get me the contracted amount I would owe with the surgery center. this is the primary place she works with so that's why they were able to get me the price so easily. I want to find out how much it will cost at the hospital but am having the hardest time getting that quote from both the hospital and insurance company. the hospital told me they would bill my insurance $7,000-$8,2000 BUT could not tell me what my responsibility would be. So then I call my insurance and ask them what my responsibility would be and they told me that they are not allowed to discuss anything more than just benefits on my plan. I"m SO frustrated. I've literally called both places 4 times or more and even called my doctor to see if she could help, but she doesn't work directly with the hospital. I'm nervous to schedule a surgery with the hospital without know how much we are going to pay.
Does anyone have advice for me? Last thing I did today was ask to speak with a manager at the insurance company and she didn't call me back so I guess i will be calling her again tomorrow. If anyone on this board works at a health insurance company I would appreciate feedback.
Re: question regarding insurance
Do you have a Summary Plan Description for your health insurance? That will give you the breakdown of what the insurance pays and what you pay, generally. Like an Office Visit the plan will pay 80% and the patient will pay 20% subject (or not) to a deductible.
If you have not been given one, you should ask for one.
Also, maybe you could ask your insurance company the percentage the plan pays for the type of service (surgery center) that will at least give you a rough estimate of the cost.
Good luck kiddo, dealing with insurance companies is not fun.
I think you may be asking them the wrong question somehow. This is something that *is* a matter of benefits. You need to know whether you have a deductible and whether your plan is copays or a split cost (like 80/20, 90/10 etc) plan. These are all things that are spelled out in the summary of benefits you received when you signed up for the insurance. It will probably go something like this - a $xx.xx copay for hospital admission and then the cost split is 90%/10%, up to the legal cap for the year (which would not be reached over an 8k surgery).
If you have a deductible and it hasn't yet been met for the year than you'll probably have to pay at least that amount.
I would get a quote from both places and go with whichever is cheapest. They will likely be billed the same way to your insurance company, and the cheaper one would mean cheaper coinsurance for you. Your deductible will still likely apply the same no matter which option you go.
If you will have to put it on a credit card in order to pay, then I would go with the hospital if in the long run it is cheaper to go with their payment plan instead of putting it on a credit card and paying fees and interest.
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When my son had surgery on his kidney, I tried to find out how much it would be so we could plan since we had to pay10%. I didn't even want specifics, just a ballpark. I had no idea if it would $10,000 or $100,000. They for some reason couldn't give me a number. It wound up being $40,000 but we didn't have to pay anything.
I think the surgical centers are usually cheaper.
I think its wrong for them not to tell you. The doc told me that the surgery center would be a little cheaper but not much. I'm just hesitant to put it all on a dang credit card that has zero balance on it. No credit card debt here, but it seems something always comes up