How much did it cost?

[SteveSW]

Between Medicare and my supplemental United Healthcare plan, the bills were paid quickly and without question. Until...a year after surgery I got a $1,500 bill from the hospital. It was for a myriad of incidental services, tests and people I had no knowledge of. I sent the bill to Medicare and United, and neither had ever received the bill. The hospital kept saying, multiple times that they submitted the bills, but Medicare and United said they never got them. United was very helpful. went through the claim item by item and had nothing. I fought it for months; the hospital turned me over to collections and I gave up and paid the bill. Insurance would have covered it, had they ever received them!

[jdsatx]

Yea BCBS denying coverage was a big surprise, turns out it an exclusion to my policy, their pamplet reads: "Any servicers or supplies provided for, in preparation for, or in conjunction with sexual dysfunctions" . My Doctors appeal for a peer to peer review went no where because the procedures an exclusion vs appealing for whether or not it was medically necessary.

Didnt have this problem for the initial implant because I had different insurance at the time, it was Aetna and all I had to pay was $1,500 deductable.

Alright. I have to ask how you were able to get Aetna to pay for the procedure? I was speaking to Dr. Clavell the other day and he mentioned that Aetna would not cover the implant/procedure. My plan was provided by my employer, USAA. And reading all the literature, I could find other sites it states that they should be able to cover that, but I’m not for certain what the deal is with those folks.

[Daytripper]

Well my original implant was in 2012 and back then Aetna covered it without any hassles. Now in 2022-23 it seems like more and more insurance companies are listing it as an exclusion to keep their cost down and employers premiums down.

The lesson I learned for next enrollment period is to ask for each plans list of exclusions before making a choice, I see now that an exclusion in my case is more important than the deductable, copays or office visit cost because the exclusion has a serious drain on out of pocket cost. Also I'm researching if a supplmental plan be added in case another revision is required. GL.

[Livingstonguy]

Funny that BCBS was mentioned. I had my surgery 12/22/22. I have a letter from BCBS saying my surgery was covered 100% (- deductible). The letter also said I should call again before my surgery to make sure nothing had changed, which I did 2 days before my surgery. They said I was good to go.

During recovery at home I get an EOB letter from BCBS saying they paid the anesthesiologist nothing and that I owe $2200 for anesthesia. None of the other charges have been submitted yet. When I called BCBS to ask WTF, they said ED surgery wasn't covered. I told them I had the letter in front of me from them saying i was covered. Now it's "under review" and I'm supposed to hear something in 7 - 15 business days. Still waiting.

Anyone know the name of a good lawyer? lol

[TurnBackTime]

I wasn't going to post to this thread, but I figure that you all might benefit from the jaw dropping image I have attached to this post. That image shows the original amount of the hospital bill (only the hospital bill, not all the other bills that go along with the operation) .

hospbill.JPG (50.28 KiB) Viewed 496 times

[Daytripper]

I wasn't going to post to this thread, but I figure that you all might benefit from the jaw dropping image I have attached to this post. That image shows the original amount of the hospital bill (only the hospital bill, not all the other bills that go along with the operation) .

hospbill.JPG

Thats crazy, looks like the hospital inflates their rates as a standard billing practice and then makes adjustments only when called on it. From $244k billed to settling for $18K. Is this practice legal?
Btw congrats on your out of pocket bill, looks like you hit the insurance lottery.

[Tokyo_123]

From $244k billed to settling for $18K. Is this practice legal?
Btw congrats on your out of pocket bill, looks like you hit the insurance lottery.

I paid cash around $18,000. Read on this forum that some with insurance are charged $150,000 and up. Can someone there please explain this, or is it just straight theft??

[advaita]

Hello,
Everything was taken care of by the French health cover.
I only paid for the additional fees of the surgeon and the anesthetist, and the supplement for a single room in the clinic.
So a total of 1100 euros.

[Old Guy]

My deductible was around $3,400 with UHC, and another $500 for the doc fee. Couple months later they sent a refund of about $550.

My advice is fight insurance if they deny any payment. Usually, an appeal will make them change their minds.
Did you know initial insurance reviews are normally done by non-medical people? They have a list of buzz words to look for under each CPT code and either approve or deny. On an appeal medical folks review it.

[ThailandBound]

From $244k billed to settling for $18K. Is this practice legal?
Btw congrats on your out of pocket bill, looks like you hit the insurance lottery.

I paid cash around $18,000. Read on this forum that some with insurance are charged $150,000 and up. Can someone there please explain this, or is it just straight theft??

You got a deal it seems. On my initial video consultation with Dr. Clavell he seemed a bit uncertain to actual cost. “About $23,000” he said. Then when i began to firm things up (no pun intended) with the surgical coordinator she said “21,000”.

And that’s what i paid. $21,000.

Less than the price of a mid-range sedan, only i’m certain that the “new” will never rub off.