Insurance & Billing
- by heather1723
- 2010-06-23 04:06:52
- Coping
- 3819 views
- 5 comments
Not sure if this is the right spot to post this but was wondering from those of you who have had a pacemaker implanted, do you remember how much you had to pay after your insurance paid its coverages? Just curious to find out how much it will cost me out of pocket once my insurance company has paid the bill that they will cover.
5 Comments
insurance
by dsaunders - 2010-06-23 06:06:59
Hi! I have a $2500 deductible and have to pay 20% of the balance. It has been about $5000. You will have hospital, all the different doctors involved. (surgeon, cardiologist, anestiologist) and follow up visits. I also have BC/BS. Trying to pay those bills and still pay over $600 a month for the insurance. I can't believe it!!
Medicaid Medicare and Insurance
by cruz - 2010-06-24 12:06:47
There's no real way to determine this, and my insurance company was no help when I called to ask. I have United Healthcare. They pay the first $500 (already met) and I pay the 2nd $500 (already paid) and then I have a $2500 out of pocket max, (also already paid), except it has exceptions. I had a Metronic pacer/defib. Surgical cost only was $92,000. I still owe the hospital about $400; I owe the anesthesiologist over $100 and the cardiologist (EF) a little over $100. I also have prescription coverage and one of my prescriptions (no generic form) costs me $47. The explanation of benefits might as well be in latin and the claims adjustor said, "read the EOB...we can't give you an estimate prior to the procedure" ....and I've paid much less than most, however, I'm still paying the insurance premiums. They now want to do a valve repair, which will be much more expensive. I had to have lithotripsy prior to the implant (LARGE kidney stone) and the cost (just for a point of reference) for exactly 3 hours at the hospital from in the door to out of the door as an outpatient was $32,000+ and I still owe the urologist $400 plus for that procedure and I owe the hospital over $400 as well. There doesn't seem to be any logic. It's as if they have a "Wheel of MISfortune" they spin to get a billing amount to the patient. Good luck on getting an answer from insurance. My Mother is on Medicare and I picked up her prescription the same day as my $47 prescription had to be filled. Her cost was 40 cents, but I'm just glad she didn't have to pay anymore even if I did. She has supplemental insurance along with Medicare that she kept when she retired, and the cost is very little.
co-pays
by gigi_c - 2010-06-26 06:06:47
Hi Heather,
I went to the hospital for an outpatient tilt table test and failed it miserably
I went into cardiac arrest for over 2 min, when I came back I was told I was getting a PM
(I had no history of a heart condition, I just started passing out, ran out of test to run so a emergency room cardiologist suggested a tilt table test) stayed in ICU for 3 days
I have HMO Anthem Blue Cross, I was billed $1000 co-pay to the hospital everything else was 100% covered (tilt table test, regular, emergency and ICU nursing staff, two cardiologist, defibrillation, ICU, EKGs, ECG, general anesthesia, pacemaker and RXs
everything)
Then I had a PM pocket revision with general anesthesia also EKG, X-ray, RX and one night in hospital 8 months later and it was 100% covered no co-pay
Try calling your insurance, if you need the information be persistent, a representative should know the answer to your question. You just have to find one willing to go that extra mile to help you
I call them angels
Good Luck
from test, diagnosis to surgery total
by Max4pups - 2010-06-30 05:06:53
was 43,000! GULP! however i had already met my 500 deductible from some other tests done here locally.
we have a 90/10 con-insurance, plus doctors office visits for us are 25. Basically we are thinking right around 3500 (give or take out of pocket...i don't remember what our family out-of-pocket max is though...
You know you're wired when...
You have a maintenance schedule just like your car.
Member Quotes
My ICD/pacer is not a burden. I still play tennis and golf.
depends
by Tracey_E - 2010-06-23 05:06:30
It depends on your insurance. You probably have a deductible to meet then pay a percentage after that. If you call your insurance co, you can probably get a good idea, or least tell you what the percentage, deductible and max out of pocket is.
I had a decent hmo (what an oxymoron, huh?!) when I got my first one and my total out of pocket was $250. I don't remember how much the next two were, but this last one, #4, has been about $7K out of pocket so far, ouch. Our new and improved insurance sucks, lol. $4K deductible then 10% out of pocket after that.
It's a wide range and the only way to really know for sure is to read your policy or call and ask. I have BC/BS and I can pull up all the invoices on their website, see what they paid and what, if anything, I owe. We don't jump to pay the bills when they come in because the drs usually send them out before the insurance pays and adjusts the amount due.