Pay up front?

...for some reason I thought that is where you live.  This is the first time I've heard anybody having to come up with "front money" when they have insurance.  I know that somebody here will have some ideas....I didn't have to face anything like that.....just paid my co-pay and the rest they billed out.....kind of a "built in" payment plan....the kind where I send as much as I can....and they just kept billing till it was paid off.

p

My husband never had to pay anything up front.  We were billed after insurance paid.  This was for both radiation treatments (2 different times) and all of his chemo treatments.  The only upfront we had to pay (co-pays) were for the doctor visits.

Ingrid K said:

Michael
You look too young to

Michael

You look too young to be on Medicare, so I'm sure you mean private insurance.  WOW, it sucks to find this issue out just the day before.  They couldn't get the OK before now ?  I was not on Medicare either, but the hospital checked right away about insurance coverage for me and luckily I had just retired from a major telecom company so I had terrific insurance and all was covered.

Definitely get to see the social worker.....they usually know all the little tricks/tips needed to help in your situation.  Perhaps the treatments weren't coded correctly and therefore denied by insurance ?  sometimes it could be a miscommunication issue and easy to resolved.

Hope you get this taken care of and you can start on the road to complete recovery.

We have to pay 15% of expenses for health care up to 2700 to meet our deductible, then insurance really kicks in.  This means right after Christmas if you have procedures you have to find money somewhere.  David has a bone marrow biopsy on the 22 so I am sure we have a big deductible to pay then.  I don't know if this is your situation or not.

katenorwood said:

Insurance issues

Michael,

I had to make a rushed descission back in '11....due to my insurance deductable coming back around in less than a month.  Would have had to come up with the first $6000 up front.  So yeah this is probably an insurance blurp.  I would hope that this social worker will have fantastic resources for you when you meet with them.  Like you needed this on top of just getting better.  Let us know if things work out....otherwise we'll dig for more resources o.k. ?    Katie

I try to stay pretty much on top of what bills to be expecting, so I'm frequently checking Medicare and our secondary to see what portion has been paid by each. For the most part, we're not asked to pay the co-pay upfront. But the hospital bill for hubby's recent stay has me stumped. The amount billed to Medicare was approx. $75,000 and all of it was Medicare approved. But the amount paid by Medicare was only $11,500. So, I'm lost on this one. Waiting now to see what UHC is going to pay. Surely this can't be right. All the many doctors involved seemed to get paid the correct amount.  Will probably end up owing about $1,000 to them. All this before his cancer treatment has even started. Haven't even see the first bill from MDA yet.

If the hospital is seriously expecting the balance of $75,000, you guys can come visit me in debtor's prison.

Luv,

Wolfen 

ausrebel53 said:

Thank you

Thank you for your concerns. I live in Florida Phrannie (Panama City Beach) and have private insurance through my wifes work, she is an RN at the local hospital where I have been going. I would have thought her insurance would be pretty good, (has been up to now) we pay over $500 per month for family insurance. I'm still a little unsure how the deductable works as we haven't had to see a doctor very much at all. Australia has public health insurance which sucks, it pays for everything but you can literally die waiting and the quality can be questionable for anything serious.

I originally came from Australia Phrannie but married my beautiful Southern Belle, Kelly....I am a permanent resident (legal)and have lived in the USA for nearly 14 years and have worked most of that time. I just turned 60 in case you were wondering.....my wife keeps me young heh heh, I do love it here especially the South.

I will definatelly keep you posted Billie, again thank you for your responses, it didn't sound right to me.

relax!!!  Medicare reduces the amount billed by doctors, hospitals,etc.  You shouldn't have to pay what Medicare and your Medi-gap insurer don't pay.  Medicare enters into agreements with health providers.  In most cases, they agree to accept whatever Medicare pays.  Since it's January, any services you incur this month will probably have a yearly deductible of $155 (off the top of my head) attached to it that you would have to pay.  This is a one time deductible.

OOOPPPS, I just reread your post.  For inpatients in a hospital the deductible is somewhere around $1100 but that is nowhere near $75000.  Sometimes a hospital will waive the deductible if it would cause a financial hardship.  They would give you forms to fill out and you would have to send them back to the hospital along with copies of your last two bank statements, proof of income, etc.

As far as insurance coverage for treatments, when I received treatment back in 2004, I was not on Medicare or Disability.  I had BCBS.  They footed my bills to the tune of over $156,000.  Neither my chemo or radiation facilities ever asked for any pre-payment.  They billed BCBS and whatever small amount wasn't covered, I paid.  BCBS is not cheap, but if you have a big illness, they are definitely worth it.

If you live in the states, I would definitely apply for SS Disability.  For certain type cancers, they will approve you without you having to fight with them.  Once you are approved for disability, you can then apply for Medicare and your bills will be pretty much be paid.

ausrebel53 said:

Have relaxed, thanx to you guys

This is certainly wierd, had my first radiation treatment today and was told insurance covered 100%, didn't have to pay a dime (whew). The rad doc said he was concerned but gave me an alternative chemo doc if we can't sort out insurance issues with the (yes I'm going to use the word) idiots at the first chemo doc. Love being in a position of strength when bargaining, I feel it's one point for our side especially since we are so vulnerable in many ways. The first chemo doc will lose a crap load of money if I choose number 2 which I am more than willing to do at the drop of a hat (greedy bast***s).

Regarding hospital care Wolfen, I used the same hospital where my wife works as an RN and only had to pay a surgeons co pay, we didn't have to pay any hospital fees of any kind. We do have good insurance but they seem to try to bluff us at times, they initially tried the pre existing number on us which seems to have been resolved.

Will keep you blokes and shielas (guys and gals) informed on the outcome of the chemo fight.

Thank you for your input

Regards Michael

and you didn't have to cough up $1700....phew!  Anyway, you are on the road, and that's a good feeling after having to wait and wait...getting everybodies poop in a group, while you're thinking the C is wrecking havoc in your body.  Glad everything worked out.

p

ausrebel53 said:

Have relaxed, thanx to you guys

This is certainly wierd, had my first radiation treatment today and was told insurance covered 100%, didn't have to pay a dime (whew). The rad doc said he was concerned but gave me an alternative chemo doc if we can't sort out insurance issues with the (yes I'm going to use the word) idiots at the first chemo doc. Love being in a position of strength when bargaining, I feel it's one point for our side especially since we are so vulnerable in many ways. The first chemo doc will lose a crap load of money if I choose number 2 which I am more than willing to do at the drop of a hat (greedy bast***s).

Regarding hospital care Wolfen, I used the same hospital where my wife works as an RN and only had to pay a surgeons co pay, we didn't have to pay any hospital fees of any kind. We do have good insurance but they seem to try to bluff us at times, they initially tried the pre existing number on us which seems to have been resolved.

Will keep you blokes and shielas (guys and gals) informed on the outcome of the chemo fight.

Thank you for your input

Regards Michael

Glad it worked out Michael. Dealing with the direct medical issues is enough, adding a financial track of issues just adds more to the plate.

Don