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I haven't gotten an answer yet from my insurance or the hospital on Cost

Discussion in 'Knee Replacement Pre-Op Area' started by Tricialen, Feb 7, 2019.

  1. Tricialen

    Tricialen junior member
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    I am wondering what my cost will be for my surgery. I have AARP Medicare Complete. Medicare is supposed to pay for knee replacements...that said I understand this. I know I will pay. My question is do you have to pay thousands of dollars up front? I will be at the hospital tomorrow and plan on visiting the billing department but I am frustrated that I can't get an answer. My plan generally pays 80%.
     
  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I’ll tag @Jamie for you, she might be able to help you figure it out.
     
  3. Tricialen

    Tricialen junior member
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    Thank you
     
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  4. Jamie

    Jamie ADMINISTRATOR Administrator

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    It is fairly common for copays with insurance to be 20% of all costs. The hospital can tell you their costs (or they should be able to anyway). But there will also be costs for the various doctors on your medical team. Their billing will be separate and the hospital will likely not know what those costs will be. Some hospitals want a set amount up front (usually not the whole 20%).

    It's good you're going to check with them. You may also need to call your insurance company to find out the percentage you are responsible for. I see there are several of these Advantage plans through AARP, so it will make a difference in cost depending on which one you have.

    Some hospitals and doctors use the Care Credit credit card, which can allow you to spread your payments out over a period from 6-18 months at 0% interest (it depends on what the medical provider sets up). If you would like this option, ask if each of your providers offers Care Credit.
     
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  5. Tricialen

    Tricialen junior member
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    Thank you
     
  6. donnag1108

    donnag1108 senior

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    For me my insurance pay 80/20. I have a 1000 deductible I had not met so I had to pay that up front to the hospital. They would have taken half and proceeded but I paid it all. I have excellent insurance through my employer which has been such a blessing. I drove myself nuts worrying about this stuff. Try not to do that it will work out I am sure!
     
  7. Tricialen

    Tricialen junior member
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    Back in August 2019 I went to an orthopedic acute care unit and after that saw an orthopedic surgeon. I asked every time...am I in net work and will my insurance cover the surgeon and hospital? Yes, was the answer. But with the surgery date coming up I was told that they no longer accepted my insurance. So I found another surgeon and practice that was on my insurance company's web page as being in network. I call my insurance. Yes he is in network. I made the appointment and asked if my insurance was accepted. Yes, it is. I asked to speak to their billing department and yes, you are in network. Okay...set up another surgery date...another pre op class and more pre op medical tests...but wait....The hospital is not in network(even though the insurance web page said it was) and they will not cover it. I can pay out of pocket if I like. So another surgery cancelled yesterday.

    I was already horribly stressed out because ...surgery...cut your leg bones, remover your knee, very painful recovery....so the added stress is just wonderful.

    I received a call from my insurance company...they have assigned a liaison and she has promised me that she can work miracles and that she will fix this mess. I am skeptical very ..but she told me that she works miracles.

    The common thread for both hospitals is that they are private w/private rooms because the surgeons want quiet for recovery. So AARP Medicare Complete by United Health Care does not like these hospitals.

    I am just letting it go...I am breathing and relaxing. I did everything right according to their rules. I cannot control it....so I have no idea if I will have the surgery or not. Maybe I will live without being able to walk more than 50 feet....
     
  8. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    How frustrating, I’m so sorry!
     
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  9. Jamie

    Jamie ADMINISTRATOR Administrator

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    I'm so very sorry you're going through this stuff when you're trying to focus on surgery and getting well. But you have the silver bullet in your corner now - your liaison person. At any point you could have requested assistance from the insurance company in the form of that liaison. But most people don't realize that! How wonderful the insurance company took the initiative. Sometimes they don't. I think you're right to let this go a bit and let your liaison person handle things.

    However, "letting it go" doesn't mean that you shouldn't still follow up on things often....at least every other week make sure you touch base with the liaison to see how things are progressing. After all, the hospital was on the insurance company's website as in network (did you print off a copy of that page for your records?). Be sure you document all the people you've talked to and when along with exactly what they've told you. Having all this documentation to back you up works wonders when problems come up. I had to do a similar thing myself with Social Security and Medicare when they made a HUGE mistake following my husband's death a little over a year ago.

    It's funny the insurance company doesn't like hospitals with private rooms. Because of the HIPAA regulations regarding privacy, most hospitals are changing over to private rooms these days.

    I feel pretty confident you are in good hands with the company liaison and that things will work out. Try to stay calm and let us know how things go. Good luck!!!
     
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  10. Tricialen

    Tricialen junior member
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    Thank ya'll...it's nice to have this place to sort of vent and find understanding. I am in no way just letting everything go...I meant that there is only so much that I can control and there is no use in getting so stressed out about those things that I have no control over. I am documenting everything that has happened.

    I fear things physically have just gotten worse for me. I have both cervical and spinal stenosis...today while out shopping with my husband I could barely walk. I could barely lift my right leg(the left needs the knee replacement). Now my right leg is very weak and there is pain shooting down the back of my leg to my toes. I know what that means having had three spinal surgeries. On Monday I am calling my family doctor for help finding a spinal surgeon. This would be funny if it didn't hurt so much.

    I am going to be okay. I believe in God and letting him shoulder this big stuff. And my husband has been wonderful. So really.... I am blessed. And I will see what happens next week. The liaison left me a message that she will call on Monday.
     
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  11. Jamie

    Jamie ADMINISTRATOR Administrator

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    Don't discount the fact that you've been under tremendous stress here lately and that can tighten muscles and create pain. The pain you're describing sounds a bit like the sciatic nerve being pinched. If you have a bad knee, that also creates the potential to keep things out of kilter and cause pain. Maybe consider some massage or therapy in addition to seeing your doctor to see if you can make things settle.

    Be careful if you consider spine surgery. I know some orthopedic clinics have surgeons that work on spines, but I learned a long time ago with my husband's spine problems that it is good to at least get an opinion from a neurosurgeon. They have skills that you may not find with an orthopedic surgeon.
     
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