House Clinic/ Insurance/ finances

[Jeremy/Erica]

I am hoping someone has had similar experience and can help with a couple of questions... My wife and I are contemplating traveling to the House Clinic in LA and having translab performed on her 2 cm AN in the near future.  I am trying to determine what our expenses are going to be.  Has anyone traveled from out of state to the House Clinic?  How did you determine what your insurance/ out of pocket expenses were going to be?

We have gotten 3 procedure codes from the Clnic.  We're going to check with our insurance, but I am wondering if there are any other things we can do to better understand what our total expenses are going to be.  I know once we schedule a date they will help us with a pre-cert for the operation, but I would love to have a fuller financial picture and more understanding of our resposibility.

If anyone has been in a similar situation and would be willing to share their EOBs with me I would greatly appreciate it.

Thanks for your help all!

[OTO]

Jeremy/Erica

You need to check with your insurance carrier if St Vincent's Medical Center and the House Clinic is contracted with that insurance company.  You might need to give them the names of the specific doctors at House Clinic.    You can expect to get bills from the following:
St. Vincent's Hospital (Blood tests, X-ray, Surgery, ICU/Hospitalization, physical therapy)
St. Vincent' Pathology Group
St. Vincent's Anesthesia Services Group
House Clinic (testing, pre-surgery consultations, surgerical procedures, surgeon's time, hospital visits, post-surgery office visit)
Dr. Stefan (pre-surgery physical office visit, tests, hospital visits and post-surgery office visit).

After you're discharged, you'll need to fill some prescriptions about 3 medicines (insurance copayment was about $20 each).

I'm from Hawaii.  My insurance is HMSA (an independent licensee of Blue Cross/Blue Shield).   For the bills from St Vincent's Hospital, House Clinic and Dr. Stefan - they submitted to my insurance company and then after the insurance company paid them and then they would billed me for the co-payments or deductibles.   For the Pathology and Anesthesia, they billed me and then sent to the insurance company, so you need to find out what the insurance company will pay and then figure subtract out to pay.

So far I have paid out-of-pocket around $3,000 or so (I can't get to the spreadsheet where I was tracking all my expenses...  I'm not on my home computer).   I do have one more bill pending.  House Clinic billed a line item for surgical assistance, and my insurance company is questioning it.   It's around an $8,000 charge, but I'm confident they will pay.   House Clinic already had to provide more information on one or two other line items.  If NOT I will appeal to the insurance company.

The other expense is lodging for my dad (while I was in the hospital) and the both of us, while I recovered for 7 days or so post-op.   We stayed at the Seton Guest Center (part of the hospital) which is $55 per day.   We ate in the hospital cafeteria most meals so I would guess food was about $20 per day for both of us...

We used our airline miles to fly first class so travel cost was minimal around $75 for the ticketing fees.  We didn't rent a car, just used Super Shuttle to get back and forth to airport (I think it was around $45 each way for both of us - included a tip). 

There's really nothing within walking distance - except a Burger King, and it's in mid-town LA (latino neighborhood).   I felt comfortable, and walked to MacArthur Park and back (very slowly).   But I can see where some people would feel uncomfortable in the neighborhood.  If that's the case, you may want to rent a car, so post-surgery you can drive to places to eat. 

[Jeremy/Erica]

Thank you for all of the information!

Oto, was most of the docs and St. Vincents covered in-network for you?

[Sam Rush]

The Omni Hotel in downtown LA has a special House clinic rate. Very comfortable with room service and restaraunts. They have a shuttle to and from House/St. Vincents. You need to check which Hospital, because the House Drs. are starting to do some of their surgeries at Cedars-Sinai,

[Desilu]

Hi Jeremy and Erica,

I have to agree with both OTO and Sam on their information. Each insurance is different. I had to pay $3500.00 out of pocket but that was my insurance. I was able to write off the cost of my flight and stay at Seton Hall on my taxes. I don't know how much it helped but I was able to do that.

As far as a place to stay and transportation, House Ear Clinic will send you a list of Hotels to stay at with discounted prices if you decide not to stay at Seton Hall. Also, we used public transportation to go places. We took the bus and sub-way for about $3.00 for the entire day. It took us to The Grove Market, Santa Monica beach, Long Beach to the Queen Mary. If you choose to sight see, all you have to do is go to a major hotel and the tour buses will pick you up there.

I wish you the best on your AN journey. If I can be of futher help, just send me a personal email.   Ann

[OTO]

Jeremy/Erica

Yes, both House Clinic and St. Vincent's were covered as in-network.

I double checked my spreadsheet, and I made alot of mistakes, because the bills and insurance statements come out of sequence. 
So far my out of pocket expenses:
St. Vincent Hospital (Surgery/ICU/Regular Rm): $0
St. Vincent Hospital (X-Ray):  $44.40
St. Vincent Pathology Group: $0
St. Vincent Anesthesia Medical Group:  $400.92
St. Vincent Radiology Group: $2.57
House Clinic:  $530.41
Dr. Stefan:  $124.37
Seton Guest Center:  $650

I have one bill pending (House Clinic is still negotiating/providing information to the insurance company).  That one is for $8,000.   I'm confident that they will come to an agreement.

OTO

P.S.  The only thing I paid before I left LA was the bill to Seton Guest Center - You pay when you checkout...

[lmurray69]

Hi, I went to house from Missouri, I have medicare and medicade in missouri, house told me they would send the bill to my insurance. but now a year later I get a letter stateing that I owe this hugh bill,I found out medicare paid 80% and all they had to do was contact missouri medcade and they would of paid , but medicade said it is too late to fill,I personally tried..so I have this hugh bill..But I loved the drs and the hospital even Seton Inn. the hospital food is the worst, but you can go to other places,Like burgerking is 2 blocks away,,good luck Linda

[nancyann]

Hi Linda - good to see you 'back on board'!   The billing dept. at the hospital should have filed the remaining 20% of the bill with Medicaid.  It seems Medicare was the primary payor, Medicaid secondary.   I would ask the hospital  'how come' THEY didn't bill Medicaid?  It doesn't seem right that YOU should be stuck with the bill for THEIR mistake.
Upon admission to the hospital they would have checked your coverage & seen that you HAVE Medicare/Medicaid.    Good luck,   Nancy

[1wareagle]

Jeremy/Erica,

 I had AN surgery, eye surgery and BAHA surgery while I was in LA. Between my deductable and what was not covered by Blue Cross and Blue Shield ,  I paid $5,298.57 ( does not include plane tickets). I hope this helps!

Ellis

[oHIo]

What insurance will pay (whether in network, out of network, percentage of policy, etc.) varies greatly depending on your policy.  Other factors include the time you are in the OR, length of time under anesthesia, days in the ICU and days of hospitalization.  As we know, all of the factors can vary greatly, depending on your case and any complications. 

At many hospitals, the anesthesiologist bills separately for their services and depending on the amount of time you were under, anesthesia services can be quite expensive.  You might find out who the anesthesia team bills through (the hospital, a private group, etc.) and also talk with them to get an estimate ahead of time. 

Two people with ANs who spend the same amount of time in the same hospital, may end up with very different looking bills upon discharge due to some of the above factors. Get as much information as you can from your insurance company, in writing, regarding coverage and your estimated percent of responsibility.