BCBC and their Allowed Amount

[Strickk]

Newbie here... I only have BCBC for reference

BCBC rep says I will be responsible for 30% of drugs agents and supplies. The hospital where I will have surgery here in Chicago says the device itself cost 26k. When I talked back with BCBC she told me that there is a billed amount the hospital will charge and an allowed amount the insurance will pay!!! because the hospital is "in network " blue cross will only pay the contracted allowed amount. My problem is they can't give me any idea what that allowed amount will be. Does anyone have any experience with BCBS ONLY other than that 30% I will be out of $200!

[KarlB1706]

I have BCBS Federal so I don't know it it is the same as yours. Yes the implant is 26,000 plus and insurance paid a good bit of that but you need to look at your total cost of your hospital bill and as well as what your surgeon charges. My total bill was well in excess of $63,000 dollars but my part for hospital and surgeon fees combined were about $2,800 out of pocket. Hope this helps you out but since you live in Chicago and I live in the Dallas area, your out of pocket could be more or less than mine.

Look at some of your past explanation of benefits and your can see what is charged and what BCBS actually pays can be quite different.


Karl

[JTVallee]

I have BCBS of MN
I paid roughly 2300 out of pocket 1-1/2 years ago

[jonbaldbg]

Yikes! $63,000?

I live Kentucky and have Anthem, Blue Cross/Blue Shield through the Kentucky Employees Health Plan.

My local urologist told me the surgery was $25,000. $10,000 was the cost of the device and his fee was $1000. The rest was hospital costs and anesthesiologist, etc.

I chose to go elsewhere to the renowned, high-volume surgeon, Dr. Andrew Kramer, because for some reason he and the University of Maryland were "in-network." I don't yet have the complete EOB breakdown of fees, but this is what mine cost:

According to the hospital:
PHARMACY - GENERAL CLASSIFICATION 328.22
MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION 17,480.97
OPERATING ROOM SERVICES - GENERAL CLASSIFICATION 4,572.81
ANESTHESIA - GENERAL CLASSIFICATION 968.22
PHARMACY - SINGLE SOURCE DRUG 18.65
RECOVERY ROOM - GENERAL CLASSIFICATION 674.71
Hospital Services 24,043.58

That's a total cost of $24,043.58. Dr. Kramer went to the pharmacy and picked up my post-surgery meds and I think he paid out-of-pocket for the deductible because I have never been billed.

However . . .

According to my insurance records (where I don't have all the specifics yet) these were the costs:
24,043.58 Pending
1,140.00 (BCBS said this was for anesthesia) My cost is $44.09
1,140.00 (Also for anesthesia) My cost is $39.20
6,172.00 My cost is $313.32

So, if I'm reading this right, according to BCBS total costs were $32495.58 which is higher than I expected. My costs so far are $396.61. Since the $24,043.58 is pending, I will probably have some charges associated with that. I question the duplicate charge on anesthesia and I wonder if the $6,172 should be part of the $14,043.58. Surely $6,172 can't just be the surgeon's fee??

The lady at Anthem who helped me get setup for this said that based on my out-of-pocket expenses and deductible for the year my costs were going to be somewhere around $650. Of course, I had airfare and hotel/food, but that was very reasonable.

I would suggest calling the number on your insurance card and hopefully you will get a really nice, thorough and helpful agent like I did. She helped me prequalify for the surgery, calculated my out of pocket costs and guided me through the entire process. She talked to me several times on the phone and some through E-mail. Make sure to get her name.

Good luck.

[jonbaldbg]

Newbie here... I only have BCBC for reference

BCBC rep says I will be responsible for 30% of drugs agents and supplies. The hospital where I will have surgery here in Chicago says the device itself cost 26k. When I talked back with BCBC she told me that there is a billed amount the hospital will charge and an allowed amount the insurance will pay!!! because the hospital is "in network " blue cross will only pay the contracted allowed amount. My problem is they can't give me any idea what that allowed amount will be. Does anyone have any experience with BCBS ONLY other than that 30% I will be out of $200!

I seriously doubt the device itself is $26,000. My local uro told me $10,000. See my other post.

[Lenny1965]

I have bcbs federal... i expect my cost to be around $3k. Using in- network doctor. Well worth the cost imho

[KarlB1706]

Lenny

Looks like your out of pocket and mine are going to be about the same. My $63,000 total was what was to sent to BCBS, the implant was billed at $26,000 but BCBS only allowed $14,000 and of that $14,000 I only paid just under $1900 with insurance paying the rest.

Good luck this month with your surgery, just remember do what your dr. says and everything will go fine, and you will have a new toy to play with for a long time.

Karl

[Lenny1965]

Karl, thanks.. can I ask why The second and implant? I thought these devices were supposed to last 10+ years. And can you keep getting replacement implants? Or is there a limit? thanks

[Lenny1965]

This site saying the implants should work 8-12 years. . . But I realize that's just the average. . Z. "Mechanical malfunction has occurred in two patients out of our first 1089 prosthesis within the first 5 years. Most will last 8 to 12 years. The more often it is used the more likely it will fail. When the prosthesis malfunctions it is easily replaced. Replacement is much easier and causes much less discomfort. Expect a minimum of 8 years enjoyment from a penile prosthesis without malfunction. Most will get 10 to 15 years and some are now over 18 years into their device."

[KarlB1706]

Lenny

My first one only last lasted about 6 years and my dr. never did tell what happened with the first one. The good thing is having the first one enlarged my penis enough that he has to implant a larger one the second time. I am hoping the second one will last the rest of my life and I hope it's a long life so I do not have to go through surgery again but if something happens I will be getting a third one.

Karl