Had the Surgery, now how do I pay???

[dano5785]

  So I had the surgery on 3/14/2011 at UCSD and am recovering nicely. UCSD was great, my Dr. is the best, staff is fantastic.

The problem: on 3/17/2011 I received a COBRA insurance letter dated, 3/14 that i am canceled, as of 2/1/2011! Had I known I was being canceled, obviously I would have postponed until i got insurance figured out. So that means pre-op, surgery, anesthesia, and post op, all of which i thought was covered, is now not at all covered. So far I have called my employer, parent company, hmo, federal COBRA regulators... and have gotten the collective it sucks to be you speech from everyone. I imagine my retirement account will now be used to cover some of the fees but no way the bulk of it.

I read on another blog the appx cost is $25,000 and on another $60,000! Is there anybody, anybody who can help me? Guide me in the right direction?

bart

[lori67]

Bart,

Wow!  That was a nice surprise, huh?

If I were you, I'd start by calling the hospital.  I know some hospitals have a maximum out of pocket amount and they will set up a payment plan for that amount.  I guess they probably don't want everyone to know about it, but when I was at VCU in Richmond, a nurse told me about it and said there was a maximum of $500 out of pocket that they could bill you for.  She said it was some new thing as of last July.  I don't know if it's just a VCU thing or if in involves other hospitals as well. 

They also might be able to offer you other suggestions when you explain what happened.  I would not even mention the retirement account as an option when you talk to them.  Also, explain the situation to the doctor - sometimes they can do a courtesy write-off of some of the charges.

Good luck and I'm glad you're actual recovery is going well.
Lori

[ombrerose4]

First of all you need to find out the specifics of your Cobra insurance. Were you paying each month for the next month? Were you up to date? Was your Cobra set to expire on a certain date- I believe the most you can have it for is 18 months.  When and if do they have to inform you of cancellation? You need to check all of this with your HR department. If the cancellation is legal, then you need to contact the hospital financial assistance department and tell them you need help. Also I would call your doctors and see if they will work with you to reduce the fees and allow you to pay it slowly. Most doctors and hospitals will try to work with you. Please try to not stress too much- you are recovering from major surgery and need to take care of yourself first. YOU COME FIRST- rest, eat well and take the time to recover. Everything else can wait to be dealt with.

[Brendalu]

WOW.....I would write a letter to your State Rep and Senator.  Not to scare you. but all of my AN stuff was over $260,000.  A lot of doctors and hospitals will write off the amounts if you are financially unable to pay and most people really aren't able and keep a roof over their heads and food on the table, plus now the cost of gas is killing everyone.  Good luck, but like others have said, get rest and take care of you, first and foremost.
Brenda

[nteeman]

Usually the hospital gets an approval for the procedure from the insurance provider when they schedule it. If they have an approval then the insurer should pay -- if not the hospital usually would inform you that the surgery was not approved and ask you how you intend to pay. It strikes me weird that this all took place after the procedure was performed.



Neal

[CHD63]

I'm with Neal.  The doctor and hospital surely would have had to have approval to do the surgery from your insurance beforehand.  Therefore, in my mind, how can they force you to pay up now?  I would take this all the way to the top claim level ...... but first, take care of yourself and try not to worry about this.

Clarice

[dano5785]

I really thank you all for your responses so far! And I will follow up on every one of them until this is taken care of. I am first going to secure new insurance as it is not just me. I also have a son with medical issues of his own. I will get that done today.

As far as the insurance- They didn't cancel me, COBRA canceled me. if you called the insurance right now, they would tell you I am current and active up to 3/1/2011. According to them, they wait until cobra sends them the money for the next month to make me current and active until the next month. Yes that confused me too especially since i am being canceled back to feb, 1.

Completely misunderstood the cobra late payment thing. they would only take a check and through the mail, so when I got a late notice i thought it was because of that. it turns out i was always paying but was running one month behind... again something that would have been convenient to know BEFORE the surgery!

I want to rest, and try to recover, I do, but I can't. I am always the over ensured fixer of things so this has really flipped my world upside down.

OK, got to find a new carrier and thanks again for the advice so far.

[leapyrtwins]

I'm a little confused here 

I just read this same post on a thread regarding insurance coverage of BAHAs.

Was your surgery an AN surgery or a BAHA surgery?

If it was an AN surgery, they typically cost in excess of $100,000

Clarification, please.

Thank you,

Jan

[dano5785]

Sorry for the confusion Joan. It was a BAHA surgery.

Dan

[dano5785]

Sorry, Jan, not Joan.


Dan

[leapyrtwins]

Thanks for the clarification, Dan.

If you haven't already, read my post on your other thread.

Jan

[LMd511]

I know everytime I went into Mass General and Mass Eye & Ear they pre-registered me-which one of the procedures was to confirm my insurance.  I would first let yourself rest, heal, and recover from this major surgery you just had and then call the COBRA insurance and the hospital or have someone close to you call for you.  Don't worry about it, just recover fully and take care of yourself. 

I wish you the best of luck!

[PaulaT]

It seems kind of odd that you wold receive a letter a month and half later that your COBRA expired. Did you happen to pay for the monthly premium within that time? If they did everything by the book, then I would talk with the hospital about setting up a payment plan and getting any other assistance.

[jodoh]

If that happened to me, I'd find an attorney for medical issues/malpractice and talk to him.

Also, my hospital would not even talk to me before they cleared everything with the insurance and who is going to pay for what (and me signing a form committing to pay what the insurance does not pay).

My baha surgery cost ~40,000 at the University of Illinois College of Medicine. University of Chicago Medical Center asked ~60,000 for the same surgery, performed by the same doctor.

Good luck with this, but do get some expert help.