I was having some medical issue (will spare you the ugly details) and initially I thought it was hemorrhoids. This had been bothering me for many years. I googled around and found a doctor who specialized in that.
Now, I have good healthcare coverage for in network doctors. When I called this doctor, I asked if they accepted my insurance to which they replied yes. I did not realize this was not the same as asking them if they were in network! This doctor was not in network.
This is where I screwed up. Right in the beginning.
I go to the doctor and the doctor says that the source of bleeding is deeper in the GI system. He recommended I do a colonoscopy immediately to rule out serious stuff. Hopefully you can understand, being very concerned about serious issues, I got a colonoscopy done with the same doctor. (I eventually had to get surgery done but that was in-network)
The way my insurance works for out of network is that the doctor bills the insurance company, and then the insurance company only pays 70% of what they determine to be normal price for that procedure. I have to pay 30% of the remainder and the difference between what the doctor charged and what the insurance company deemed to be normal.
I saw the claims and I am just in shock at what the doctors have charged and how little the insurance company deemed to be normal. For example,
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Injection of propofol: Dr charged $11,250.00 and the insurance company deemed that the normal cost is $21.75 and so thay paid $19.43. Apparently I am still on the hook for the remaining ~$11,000!
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Surgical trays: Dr charged $875 and the insurance company paid nothing. I am on the hook for all of this.
All in all, the total claims are around $50,000! And the insurance company will pay only a fraction of that.
I have not received a bill from the Dr's office yet. But I am dreading the worst. I cannot afford this at all. And I don't understand what I can do -- how can I be expected to pay for things like, $12,000 for 10mg of propofol or $1,000 for surgical trays!
I know I screwed up going out of network. I was just confused by my initial conversation with the Dr. Accepting an insurance doesn't mean in-network.
Do they seriously expect me to pay the difference? I dread the bill. What will be my options here??
Thank you
Submitted August 31, 2017 at 07:39AM by BulldogTotal http://ift.tt/2xOW6zn
