Insurance Ramblings

So, I originally thought my insurance would pay 100% of my WLS since my sinus surgery on April 11th will cover my deductible and, I expect, all of my out of pocket for the year. Then, I was told it will only cover 50% after I meet my deductible and that there is no out of pocket maximum. I'm still waiting on final confirmation of this but I suspect this is the case. Oh, and if I go with insurance, I have to have it at a Center of Excellence. Only hospitals qualify as a Center of Excellence. My doctor does the majority of his surgeries at at "outpatient" surgery center where you can stay confined for up to two days to help cut costs. If I have to have it at a hospital, my fees would greatly go up. The office told me I'd be better off paying their cash price ($12,200.00) then to file insurance because my 50% would definitely exceed the cash price being that the hospital fees are quite hefty. I kinda got it in my head that I'd be paying cash for the procedure but was still holding out hope I had better benefits than having to pay 50% of the bill.

Then today it happened. The lightbulb in my head turned on. I shouldn't have to pay 50% of the total bill. I should only have to pay 50% of the amount of approved charges by my insurance, right? Well, I called my surgeon's office and they were closed. Patience is not my strong point, so I decided to call another local doctor. The insurance girl there confirmed my thoughts. She told me my 50% of the physician's approved charges would only be around $500 to $600! OMG! That is great! Now, I know the hospital charges will be higher than the doctor's and thus a higher approved amount but it still shouldn't total their cash price of $11,900.00. The lady at the doctor's office didn't think so either but told me I'd need to call the hospital to verify. Unfortunately, they were closed for the weekend so the wait contines. One thing I do know though is insurance companies pay WAY under what doctors and hospitals bill. My sinus surgery physician's fee is over $11,000 but the approved amount is only a little over $2,000. It appears it will be that way with the WLS surgeon based on my conversation with a WLS office today. Therefore, I assume the hospital approved fees will be the same way. I can't wait to find out! So much so, I almost wish it was Monday now. See, I told you patience isn't my strong point. I'm just hoping I get to keep more of my money in my bank than I originally thought.

Woo Hoo! (I hope)