ANA Discussion Forum
General Category => AN Issues => Topic started by: gwh on May 10, 2011, 06:40:33 pm
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looking to get an understanding of out of network costs at House for translab surgery?
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around 40,000$ that was 2 years ago. I did sue my insurance company afterwards and won..all of my money back. they wanted me to go in network
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Mine was $52,000 in Nov 2008, but that included a facial nerve graft and BAHA implant. I think the first set of charges was over $200,000, but by prior agreement, the $52,000 is what was paid.
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Depends on your insurance company...I had Aetna and my HEI doc was out of network but still signed on for the Aetna national plan. However, since you don't technically pick your neurosurgeon (or anesthesiologist for that matter) the insurance company (from what I understand) must pay for service. BUT I could be wrong! I went round and round with my insurance company and ended up paying around $250 after I had met my out of pocket max. I am happy to talk to you offline about specifics if you'd like! I know that it is confusing. Thankfully my mom worked in insurance billing and stayed on top of it and knew what to do because I wasn't in any shape to deal with it post surgery :P Good luck!
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I went through the same issue. I live in Texas, and my wife's best friend's sister is a surgical nurse at HEI. Of course, the nurse said I had to get it done there. Dr Friedman was the doctor. Same "out of net work" issues popped up. Not willing to risk my retirement on a lot of unknown cost, I started looking for a local surgeon that could "cut and paste" on my old head. If you go to HEI, they want you to stay for 2 weeks. Through some contacts on this site, I found a great doctor in Houston, was in the hospital for 3 days, and went home as a happy camper.
I certainly won't knock HEI, but with a little bit of research here, you can probably find a local doctor that can do this surgery. I found 2, and one wanted to do radiation, and one thought surgery was the answer. HEI recommended surgery after looking at my MRI. I would have been perfectly happy with either doctor locally. Do a little home work and think about staying home. You can interview the docs and I'm sure you can draw your own conclusions.
The idea of being stuck in a hotel in LA to recover did not sound very inviting to me...for 2 weeks. My own bed was a great place to recover. My wife's cooking beats anything a hotel can dish out. I could sit out in the back yard and watch the river roll on by. Home is a great place to recover...and I had no "out of network" expenses, and I am retired without all of that debt.
James
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Some insurance companies will give you what is called a "Gap Exception", basically making a out of network provider in network for your case. I did it with SBI when I had scheduled my surgery last November and it was approved with a phone call. SBI might be unique because there aren't many that do endoscopic AN removal's so this might have been a unique situation for me. There are many places that do the traditional approach so this gap exception thing might not work for. You might be able to make a case the House is unique because of their expertise in AN removal.
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Just had translab and abutment surgery at HEI. I paid $100 copay to the hospital, plus the remaining $240 in my out-of-pocket. Then $150 for BAHA evaluation. $10 copay to Dr. Stefan. $550 to House Ear Clinic for the Oticon Ponto Pro and doctor copay. Presume the rest will be covered.
Clarice
P.S. Seton Hall Guest Center was very comfortable for the two weeks. Great bed, nice sized rooms, made many new friends.
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I certainly won't knock HEI, but with a little bit of research here, you can probably find a local doctor that can do this surgery.
I totally agree with James. I had my surgery close to home - couldn't have imagined it any other way. My doc was incredible, very experienced, and did an outstanding job. I had a wonderful outcome. At the time I hadn't even heard of HEI, but even if I had, I would have made the decision to have surgery in "my own backyard".
Not everyone can financially afford to travel to LA and lots of us have "lifestyles" that wouldn't allow it either. For example, I'm a 24/7 single parent with two children (who were 11 at the time of my surgery). I was much better off close to home with my caretakers (family members) who could be there to help out during my surgery and recovery. Relocating all of us to California wouldn't have been an option.
Jan
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I have Cigna, and I got approval to have my surgery done at House...I paid my co-pays and that was all I had to pay. They were considered "in-network" and so they had a "Contract" with Cigna...I later got all the statements from the insurance I was floored...the Neurosurgeon bill Cigna something like $67k and Cigna paid like only 10% of that, and because of the "Contract" I didn't have to pay any difference...makes me wonder how these doctors continue to accept insurances like mine??
Jay