Finally, My EOB's from Insurance Are Surfacing

[DesertGal]

I check every few days on my insurance's web site to see WHAT we owe for the surgeons part of the bill and the hospital. I could never get a straight answer BEFORE surgery from our insurance (BCBS FEDERAL) because they would tell me "We don't know what the surgeon will submit and I won't know the allowable charges." So I phoned yesterday and finally got an answer: The surgeon submitted his bill for $15,285.00. The allowable charges were $2518. (or close to that). Our responsibility is $377. Which we already paid a week before surgery. His office required us to pay $465. plus an additional, non refundable $500. for a "program" I had no idea I had to pay before this date (one week before surgery.) SO it appears they will owe us a small refund.

Now, for the hospital's charges. Not processed yet. The hospital submitted $131, 436. dollars to our insurance. But the hospital screwed up and submitted it to Medicare, even though I only have Part A (hospitalization only). So our insurance didn't pay atteniton closely and processed it as if I have medicare, and not only that... it was submitted as inpatient, which it was not. Outpatient with observation. So I foresee a pain in the ass sorting it out. BCBS FEP did tell me that once I receive the Medicare Summary in the mail, fax it to them and it will be input, and straightened out. Our insurance has been SO good with me all throughout this whole process. What a mess!

[Bagawk!]

I'm confused by all that,... lol,... but I hope things resolve for you painlessly!

[DesertGal]

The surgeon's bill is taken care of.
The hospital... that's a long story. But, it will be taken care of once its all figured out.

[Christie13]

I hear you. I have had a few bills that came months after the surgery. The oddest ones being 2 bills at over $300 each for something that the insurance did not cover with the anesthesiologist. I was like WTH would not be covered for that? And then a small one to the surgeon for $73. Everything else was smooth. So overall, no complaints. All of it has been money well spent.

[poodlecamper]

I found out that Medicare would not pre-approve my surgery BEFORE I had it done. So I had to pay $4750 , found this out a week before surgery.
Post op, coverage was denied. The second time it was submitted it was ok'd and I got my money back. Made me nervous ,never experienced surgery being approved after it was done.

[DesertGal]

I don't have Medicare as primary insurance and there was no need for any kind of prior approval. But the billing people at the hospital submitted the bills to Medicare where it clearly say's PART A hospitalization only. Several weeks back when I was on the hospital's web site on my patient portal, I saw that they billed Medicare. When my husband called them on it, they said "Oh, we'll correct that today." And they didn't.

My primary insurance approved the surgery and I have the papers they mailed to me, so I am not worried, but it's just the added extra work isn't thrilling to me (phone calls, faxing, making copies, etc....). But our insurance people also had someone who entered into the system that I was INPATIENT, which I was not. So again, assuming the hospital biller had that entered into the system as well.