ANA Discussion Forum
General Category => Insurance => Topic started by: spgreenfield on December 09, 2011, 11:46:41 am
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What costs are associated with the surgery that would impact out of network vs. in network? I'm leaning towards HEI but since they're not in network wondering what that really means in dollars......
Pam
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Lots of costs with surgery.
There are the surgeons (in most cases neurotologist and neurosurgeon), the OR, the recovery room (immediately post op), the facility (hospital room post op plus nursing care), and the anesthesiologist. They also typically do a biopsy on a piece of the tumor - just to confirm that it is benign (99.9% are) - which means lab and radiologist fees.
Most docs also monitor your facial nerve - so there might be a fee for that. And the OR charges usually include things like "supplies" - which probably includes the cost of the high-powered microscope that the docs use in surgery.
Most AN surgeries cost in excess of $100,000
Jan
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I have confidence in BOTH places....but selfishly I like the idea of the weather in the middle of January in CA - NOT OH - but I also need to be a responsible person throughout all this....so choosing based on IN network vs. OUT of network wouldn't be totally off base?
Pam
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Pam .....
Just a thought ..... check with the insurance people at HEI and see what your actual cost would be ..... before eliminating them as a possibility. I know they work all the time with people who have out of network or NO insurance.
Clarice
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What costs are associated with the surgery that would impact out of network vs. in network? I'm leaning towards HEI but since they're not in network wondering what that really means in dollars.
Pam ~
Virtually all of the costs of your AN surgery will be included in the 'out-of-network' insurance coverage provisions of your policy if you opt for HEI. Because every insurance company has a slightly different rate structure you should look at your medical insurance contract information or call the insurer and ask them. Sometimes the contract language will be ambiguous and use the term 'reasonable and customary' to set the amounts they'll pay. However, most medical institutions have contracts with insurance companies and agree to accept what the company pays, although, in most cases, whatever the insurer doesn't pay (usually stated in the contract as a percentage) you'll probably be liable for... unless the doctor and/or institution agrees beforehand to waive the remaining costs beyond what your insurance agrees to pay them (don't count on that happening). That's what's on some of the many forms you'll be asked to sign when you check into the hospital (any hospital...they all do this to protect themselves) so know exactly what you're signing and get the payment arrangements clear, especially if you'll owe the hospital. Most medical institutions support some sort of payment plan although they usually want you to agree to pay your bill in full within 12 months, but those agreements are situational, specific to the institution and the patient's negotiating skills. However, most hospitals are reasonable.
I suggest that you make some phone calls (HEI, your medical insurer) and know where you stand, financially, before opting for or against HEI, the institution you stated you would prefer to use.
Jim
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I have been considering the House Clinic for radiosurgery, but I have Medicare as primary insurance and the House does not accept Medicare..!! I'm trying to gather info on the Ear Institute of Chicago and the Illinois Gamma Knife Center in Elk Grove, Illinois. Is anyone familiar with these medical centers and their physicians?
Thanks for your help. Theodore
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Theodore -
I am VERY familiar with the Ear Institute of Chicago. I had my AN surgery and my BAHA implant done by Dr. Robert Battista. He also does GK @ Alexian Brothers.
If you'd like more information on Dr. Battista and/or Chicago Ear, please send me an email (my email address is in my profile) or send me a PM (personal message) through the Forum.
I'd be more than happy to talk to you.
Best,
Jan