not quoted cost of procedures

[go22]

What is the name of your state? new york

hello friends,

i have a dilemma and was hoping someone could properly advise as to how we could proceed.

my wife needs vein closure surgery in both legs. we have insurance which advised us that they will cover the costs 90% and we will be responsible for the remaining 10% which is fine, but when we asked the vascular surgeon (who is in network), and his staff what the cost they would bill our healthcare would be for each proceedure they told us they would not know until the proceedures were done and we would then find out what our cost would be from our insurance provider when we receive our explanation of benefits.

we are concerned about this complete lack of cost information and also called our healthcare provider. they asked us to get the proceedure codes for each procedure and then told us they could tell us a ball park figure as to what the cost would be for us to pay as far as our 10%.

got the procedure codes form the vascular surgeon's billing dept, called out healthcare insurance and gave them both codes only to be told the same thing and they cannot tell us what the cost will be for the 10% we will be responsible for.

now we are waiting for authorization from our healthcare to go ahead with both vein closure procedures, and when the surgeon's office receives it they will call us, but both the wife and i are really worried as to not knowing what our 10% out of pocket cost will be.

isn't the patient legally entitled to know that information BEFORE THEY HAVE any MEDICAL PROCEDURES DONE?

please advise and many thanks, and any suggestions would be greatly appreciated....

"after all if they bill thousands to have 2 procedures done i need to know what we are legally responsible to pay for regarding out 10% before any procedure is done, and this is a life threatening situaiton regarding blood clotting as displayed by the doppler tests done on both of my wifes legs at the surgeon's office.

i respectfully await replies, many thanks, and sending you all blessings.

[cbg]

There is no POSSIBLE way they can give you exact figures beforehand. It simply cannot be done. Medicine is not an exact science - you're asking them for the impossible. Many, many things can change during the surgery which can then change the costs.

There is NO legal obligation that the provide you with an exact cost beforehand; if they are willing to provide ballpark figures that is the best you're going to get and all you're entitled to.

[go22]

i do understand about unforseen costs, but was only asking for a ball park figure.

from what i have been told both of the new york healthcare insurances, and the surgeon's office refuse to give any figures whatsoever.

will just have to put this on hold for the time being.

cannot afford having 2 major procedures done and not having some sort of idea what our personal cost will be .

thanks very much for your reply.

[ecmst12]

You know there are dozens of codes billed for major surgeries. And there's the surgeon's fee, the facility fee, the anesthesiologist's fee, pathology (if there is any needed), etc. So even if you get a ballpark figure from the surgeon, don't expect that to be your only bill.

[go22]

thanks so much for posting your additional reply.

yes both my wife and i are aware that there are many added fees, but all we wanted to know was some kind of ball park figure for the cost of the entire vnus closure procedure done on both legs the vascular surgeon would bill my healthcare, and then we would have some idea where we stand financially regarding our personal out of pocket costs.

we are of course are aware that there will be extra fees to pay out of pocket for additional services not covered by our healthcare providers, for services performed by other various specialists associated with start to finish of the above medical procedure.

again, thanks so much for taking the time and replying......both the wife and i greatly appreciated it.