ARGH- Stupid Blue Cross PPO - ThinnerTimes

RuthB · 12-27-2005, 08:36 PM

WOW! I just got a $700 bill from the Anesthesia group used during my surgery. Turns out, they're not a Blue Cross PPO Participating Provider. Since I didn't have a choice in the matter, I'd like to file a claim with the insurance company but I wanted to see if anyone else ran in to a similar problem and decided to take action. If so, were you successful? Any help is appreciated!

SDphotogrl99 · 12-27-2005, 09:42 PM

I am 2 and a half months out and I get bill after bill. I am over $3000 in bills after WLS. I had to pay Dr. Wittgrove $8000 on top of that.......Now what is insurance for anyways.... lol.......I have blue cross ppo too. They pay thier part and I have to pay mine. It sucks but I think it was worth it

melanie hirschorn · 12-28-2005, 09:58 AM

it depends on your insurance. check with them. i had mine covered under the hmo component of my insurance and i remember getting billed afterwards for stuff from the hospital for lab work and i just called them up and told them i shouldn't be paying for this because it was approved by my insurance and they said it was just an error. it might be different with ppo. next week i go in for gallbladder surgery and again it's under the hmo part of my insurance and all i pay is $15.
melanie

coptergirl · 12-28-2005, 10:11 AM

PPO's are great bc you can go in and out of network, but you pay for PPO's not only through your employer, but also when services are rendered. Blue Cross gets a negotiated rate for services, and generally with their PPO, they cover 80%, and the patient covers the other 20% of the negotiated rate. I chose not to have the BC PPO bc of this - how will we ever know what the negotiated rate really is? WLS is generally a $60K surgery, and BC's negotiated rate is typically $25K - so PPO covers $20K while the patient gets the $5K to pay...plus they are paying more on the front end through their employer in their monthly deductions. Even as a benefits administrator at work, I chose to go with the HMO for this fact - my surgery will cost $250.00 for the hospital stay. Period. I would rather have this than have to worry about a "negotiated rate" and higher monthly premium....Just my 2 cents

new me · 12-28-2005, 12:36 PM

Ruth,
Give them a call and ask for a discount due to the circumstances. Most physicians are understanding to these issues. Good luck.

8 days to go...(And I am coughing again. AHHHH!)

brookscn · 12-28-2005, 01:06 PM

Quote:

Originally Posted by RuthB

WOW! I just got a $700 bill from the Anesthesia group used during my surgery. Turns out, they're not a Blue Cross PPO Participating Provider. Since I didn't have a choice in the matter, I'd like to file a claim with the insurance company but I wanted to see if anyone else ran in to a similar problem and decided to take action. If so, were you successful? Any help is appreciated!

Ruth:
When I went in to talk to Kelly in Dr. Callery's office, I was told to check with the anesthiologist to find out if they were covered under my insurance. I did check, and was told no, that Dr. Filiciotto is not a blue Cross provider. However, his office told me that because they work with Dr. Callery, if the insurance states any adjustment, they will try to give me that break and bill me for what they allow. I was told that his cost for assisting is $1175, and that's what I would be billed. I'm hoping that my insurance will consider him out of network, and only charge me my percentage for out of network.

If my reasoning is wrong, someone please let me know. Insurance makes my brain hurt (hey, is there an operation for THAT?)

Carolyn

NelleBelle50 · 12-28-2005, 04:31 PM

Call your customer service and tell them that you had no choice of who your anesthesiologist was.

I know in the company I work for (Blue Cross MN) if the hospital bill is covered as PPO, we up any of the other prov's assiting to PPO level..... It's like the hospital's status is the umbrella encompassing all other prov's during your surgery and stay....

It can't hurt to call, and if nothing works, appeal in writing, and appeal again, then appeal some more.....

Good luck!