Some Drs. Actually Care

[singletracker]

I had a cervical TDR in May 2010. Everything was preauthorized by the insurance, and I confirmed that the hospital was in my network, as well as, the surgeon. The only problem is that the surgeon's office visits were only covered as in-network at one of his office locations.

Long story short, the insurance paid as it should on everything until the surgeons bill came due. The primary surgeon and the assistant surgeon (also a neurosurgeon) billed out at the same amount. The insurance only paid about 25% of the assistant surgeons bill, which left me with an unexpected $8,700 bill. I didn't even know there was going to be a second surgeon involved. They also considered the primary surgeon as out-of-network, which raised my out-of-pocket maximum by $1,000. Total unexpected charge of $9,700. The insurance wouldn't budge, so the surgeons gave me a break and wiped out the remaining $9,700. I think the primary reasons were because they new everything had been preauthorized, the second surgeon was probably being trained on the ADR and they actually care about their patients. What a relief!

[Harrison]

Wow!? This is not a story one reads every day. I hope you do something nice for the doctor or crew that made this happen! Hmmm, not sure what I would do...flowers?!

[jss]

WOW!

It's a good thing that some doctors care, because the insurance companies sure don't!

Congratulations on getting all of that taken care off. And, it's good that you're still doing well.

[singletracker]

I guess the nicest thing I can do is recommend them to others. The only way that I found out about them is from word of mouth, and it's all been good. So I guess I'll spread the word also.

[Toebin]

This is certainly something that anyone having surgery of any kind needs to consider. I too was hit with a huge bill after my cervical fusion surgery. It was for the specialist that monitors my nerve conduction during the surgery and was for $7k ... a totally unexpected portion of the bill and not something I had any control of.. but...

This guy was not a subscriber to my Blue Cross insurance and they would not cover his charges.

Fortunately my employer at the time was self insured and they choose to instruct the insurance company to cover the "reasonable and customary" charges for this portion of the procedure.

There are many members of a surgical team, many of whom we never know about that are present when we have an operation. Despite making sure your facility of choice, surgeon and follow up is within your insurances network.... there may be those involved in your care who are not. And this really makes the consumers homework a LOT more difficult :eek2:

[2Confused]

Wow! That is good to hear! Sounds like you have good doctors!

[NJ Gene]

I have an insurance policy from Empire Blue Cross/Blue Shield known an an EPO. This is a policy offered to NYC and NY State employees. My wife is in Special Ed for the NYC Board of Education. I like it a lot. One can go to any specialist within the Blue Cross network nationwide and all that's required is a $15.00 copay. The downside is that you cannot go to any providers who are out-of-network. Most of the doctors I use are in-network anyway. Interestingly enough, the ones I have the most difficult time finding in-network are spine surgeons (at least in NJ). If I go into NYC, there are plenty of them in-network.

Here's the other thing I like about my policy. There are no surprises. If you have surgery by a participating surgeon at a participating facility, you are not responsible for other physicians involved who are not of your own choosing (i.e. the anesthesiologist, other physicians involved in the procedure that you're unaware of, etc). My insurance will pay these physicians at the in-network rate. However, if they don't want to accept the in-network amount, my insurance will negotiate with them. Often times, those out-of-network physicians will get the entire amount that they bill from Empire. Obviously they make out the best.