BAHA out of pocket payment

[kma]

I had my BAHA surgery at the end of July and in six weeks, I'll receive my processor.  I was told that I would need to pay $500.00 at the time I get my processor ~ the doctors office does not submit the bill to insurance and that the $500.00 was my responsibility to pay.  I'm fine with paying the $500.00.  My insurance company is Blue Cross/Blue Shield and with all my medical bills this year, I have met my out of pocket maximum and am currently not receiving any medical bills and will not be through the end of the year.

So, I thought I would pay the $500.00 and then submit a claim to Blue Cross and see if they'd cover it.  I called Blue Cross and they told me how to do it (form, copy of my payment receipt, doctor's procedure code, etc.)  I then called my doctor to tell them what I planned to do and to find out what the procedure code is and they said they do not have a procedure code or a billing code because people just pay the $500.00 and never submit it to their insurance company.  Well, I'm thinking that seems silly and I can't be the only person wanting to try to get reimbursed for it. 

Does everyone pay the $500 out of pocket and has anyone ever tried to get reimbursed from their insurance company? 

If anyone has a suggestion for me ~ please let me know.

Thanks!!

Kathy (kma)

[Jim Scott]

Kathy ~

I think it's a bit supercilious for your doctor's office to refuse to submit their charge to an insurance company for payment, but you seem O.K. with it so who am I to complain?  Besides, I can see that you really have no choice but to try submitting your own claim to recover the $500. you've been forced to spend to obtain your processor.

I would call Blue Cross, explain your situation (that you're submitting your own claim) and ask the rep to give you the proper procedure code.  They should have that information available.  I wouldn't accept any excuses.  There is no way you could know the procedure code number and it shouldn't be considered proprietary information in the sense that they require it to pay a claim and your doctor's office is refusing to give it to you on what I consider pretty specious grounds.   I hope you're successful with your claim.

Jim

[JerseyGirl2]

Does everyone pay the $500 out of pocket and has anyone ever tried to get reimbursed from their insurance company? 

Kathy (kma)

No, I didn't pay $500 out-of-pocket for my BAHA.

Re: your doctor's office being unwilling to submit any of their billing (or other) information to your insurance company -- I was talking to a friend last week -- nothing to do with BAHAs or acoustic neuromas, by the way --  who mentioned that one of her doctors won't submit anything to an insurance company which would enable her to possibly get a refund or at least get counted against her annual deductible. It seems like an odd policy and I can't imagine what the reason would be.

I hope you can get this resolved ... or at least manage to do it without the assistance of the doctor's office.

Catherine (Jersey Girl 2)

[leapyrtwins]

I paid nothing for my BAHA surgery or my Divino.  My insurance company paid for everything - I had already met my deductible for the year.

Good luck; I hope this all works out.

Jan

[mellowrama]

Kathy,
That is what I was told also by the audiology doctor about the 500...  I didn't think about sending it directly to BCBS.  Sounds like I'm on the some boat as you, please let me know what you discoverd as i would like to avoid any additinal costs.
thanks, melinda

[leapyrtwins]

Good point, Cami. 

Doctors pretty much make their own rates for BAHAs and build in their own profits.  If you are able to negotiate with your doctor before the fact you would be able to save some money.

Flexible spending plans (aka cafeteria plans) also cover hearing aids of any type including the BAHA.  My insurance company paid for my Divino, but I'll be funding the BP100 out of my flexible spending plan in 2010. 

Jan