Big surprise in mail

[DonDon]

I did not proceed until my hospital confirmed that Humana (Adavantage HMO) and Medicare would cover it as "outpatient surgery". Cost me $200. I recommend not doing anything with such high $ exposure without a confirmation letter. Good luck on your appeal.

[Anonymous3]

Just going to have to wait till I get a new bill from Dr. In the what we don't cover section for GEHA "sexual dysfunction " but if you want change sex they pay for almost everything and possible breast implants, but if a man want to stay a man a function they will not. That fucked up

[medhatg]

I did shopping around for the total all-inclusive cash cost of the implant in both US and Canada and the lowest was 20K in Canada and the highest was 40K in Florida (all is USD$). I'm just curious, how come I see those 75K+ numbers in the thread? Is cash cost lower than the cost billed against the insurance in the US?

[Anonymous3]

I did shopping around for the total all-inclusive cash cost of the implant in both US and Canada and the lowest was 20K in Canada and the highest was 40K in Florida (all is USD$). I'm just curious, how come I see those 75K+ numbers in the thread? Is cash cost lower than the cost billed against the insurance in the US?

Yep

[Lost Sheep]

I did shopping around for the total all-inclusive cash cost of the implant in both US and Canada and the lowest was 20K in Canada and the highest was 40K in Florida (all is USD$). I'm just curious, how come I see those 75K+ numbers in the thread? Is cash cost lower than the cost billed against the insurance in the US?

Yep

To extend a little bit on medhatg's pithy reply:

Insurance companies get a list of "preferred providers" price list, In exchange the ins company funnels business to those providers. That is why quote "out-of-network" providers are more expensive to the patient. Then there is a table of "usual and customary" that many providers agree to for workmans compensation claims and other institutional Insurance based charges. The EoR the original poster refers to probably uses one of those tables. Needless to say, the tables are not perfect and the people who use them are sometimes imperfect as well. So, that is where resubmission and appeal come into play.

That is my little essay about how the United States Medical Care system pricing anomalies are able to exist

[jackhammerdreamz]

Best of luck on getting it sorted out!

I have a feeling it's a mistake that should be cleared up.
I made sure to speak to my insurance before seeing an implant specialist. (if physical impairment and not psychogenic, they cover 90% so I'm only out about $3k)
Then when I spoke to the surgeon, they called my insurance to verify any prior authorization or referral needs.

I'm astounded that your surgeon's team didn't confirm costs with you and verify with your insurance on the cost.
Surgeons are usually paid up front, so it has to come through your insurance before they'll proceed.

Very strange and that shit is complicated and a massive headache.

btw I don't think trans surgery has much to do with why they don't cover your surgery.
Unless it's a vast conspiracy on infowars or something lol.
I understand your frustrated though.

Good luck in getting that bill cleaned up!!

[Zxylpk]

Zxylpk wrote:
Mine was $85k. Medicare paid 100%. Looks like someone screwed up the paperwork. They need tofix it and resubmit.



Is it just me or is anyone wondering why there seems to be such a HUGE difference in the cost of this procedure. In Canada, this procedure cost about $33,000 USD.

Our system is broken. They charge the least if the patient is paying out of pocket. They charge more if the patient has insurance. They charge the most if he has Medicare. Because they can. Someday we might get a more sensible health care system like Canada.

[Anonymous3]

I talked to the insurance lady today. It not 60k. That just what the billed. She told me she has never seen GEHA not pay when they are secondary. She is investigating. Also called the Office of Personnel Management. I have to appeal to GEHA then I can appeal to them. Since it is government I can always contact my congressmen to start an investigation.

[Larry10625]

I talked to the insurance lady today. It not 60k. That just what the billed. She told me she has never seen GEHA not pay when they are secondary. She is investigating. Also called the Office of Personnel Management. I have to appeal to GEHA then I can appeal to them. Since it is government I can always contact my congressmen to start an investigation.

Well, that's promising

Larry

[medhatg]

Someday we might get a more sensible health care system like Canada.

We've our problems is Canada with socialized medicine. Doctors have a ceiling on what they can bill the government who is their only client, so the specialists end up working 6 months and the 6 months in the Caribbean, and that leads to long wait times to see a specialist. Since seeing the doctor is free to the patient and paid a 100% by the government, the family doctor is my mother's and other's favorite destination if they are bored and want to talk to someone. The system is heavily frauded by overseas foreigners and the tax payers end up paying for it. To Hugh's point, sex change is considered an urgent surgery and will be put in-front of the line for political correctness sake, while an implant is considered an "elective" procedure and the urologist has to write a "thesis" to a bureaucrat to get approval to get it funded.