Simple healthcare question: What will this procedure cost me?

Parent Cafe
21

<p>Amusing, coming from someone who claims never to go to the doctor :slight_smile: And, not correct</p>

<p>Predetermination is NOT s guarantee of anything. You may or may not get it, and it takes time, often several weeks, to get a response to this request from your insurer.</p>

<p>An EOB comes AFTER a claim is processed, not before.</p>

<p><strong>ETA</strong> Here is a sample predetermination explanation from BCBSIL. <a href=“http://www.bcbsil.com/statefarm/predetermination_of_benefits.htm[/url]”>http://www.bcbsil.com/statefarm/predetermination_of_benefits.htm&lt;/a&gt;
NOTE the * after referencing that it lets you know if its covered. Look at the bottom, and read the ever present “*Quotations of benefits and/or the availability or extent of coverage are not a guarantee of payment. Payment is subject to actual information and charges submitted.” caveat.</p>

<p>OP -Please listen to the posters in the field who can give you more accurate information.</p>

22

<p>What fendergirl and jym said. I am an office manager in a doctor’s office. “Blue cross” has many fee schedules, and just by looking at your card, I can not know what all the charges for everything are. I can not easily find out on line either. (Although I can do this for many plans of United Health care on line…)Yes, I know a few fees for the top billed procedures for a couple of fee schedules, but it sounds like you are going to a big medical center where the doctor may not even know what fees are paid on an individual basis…</p>

<p>I hope you get an answer. If you need tests, by all means, do them…</p>

23

<p>^The only way to make computer talk is to request pre-determination. I imagine, that as an office manager you have requested many, anothermom2, or heard from your “insurance” person that he/she did.</p>

24

<p>I got a phone call today and the nice lady gave me the total estimate, $966.40 which is an estimate. The list price was $2062. In this case the information came from the provider (Carolinas Medical Center’s “pricing line”) and not from my insurance company, Blue Cross Blue Shield North Carolina. This is the first time I have contemplated a medical service that goes against my deductible so there was a learning curve and I get frustrated easily. I remain very happy with my medical care and my insurance policy (that we pay for privately) here in NC. </p>

<p>$966 is a lot better than $2062 but I am going to hold off for now for a variety of reasons.</p>

<p>Also, I have another thread going about actual charges vs estimate on a family member’s minor surgery. That was a university student’s Blue Cross policy that requires a 10% co-pay, so on a $7000 surgery he had to pay $700. If I had that same surgery under my policy I would have had to pay the first $2500 plus 10% of the rest or a total of $2950!</p>

25

<p>I would kill for your deductible! Our Blue Cross is $1700 month with a $13,000 deductible. With our policy we have found the diff between billing rate and BC negotiated rate is about 30-40%</p>

26

<p>Congrats, NJres. I would still ask for some kind of paper. You cannot use telephone conversation when you will pay. Would be nice to have a paper with the number in your hands.</p>

27

<p>Congrats on getting the update, NJres. If you have the name of the employee you spoke with at the providers office, and had her document your file (assuming you’ve been there before and have an established file) that should be adequate. When my billing person calls for benefit verification and coverage, she gets the name of the person and sometimes the employee ID # if necessary.</p>