(United states health insurance question)
TL;DR I have an estimated cost and a pre-authorization for a CT scan from my insurance provider but I don’t trust it based on what I’ve heard from the provider. CT scan provider says my OOP will be very high and I just just pay the direct (no-insurance cost). Insurance estimate says the fee will be reasonable. Who do I trust?
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This is really driving my crazy. My doctor orders a CT scan of my pelvis and abdomen. His office per-authorizes it with my insurance and sends the order to the facility he’s affiliated with.
I do my own research and find that this should cost me between $500-$1000.
The facility calls me prior to the appointment and tells me my OOP responsibility is $2800 and they ask for my credit card on the spot. (I have a $5k deductible).
I cancel the appointment.
I go to my insurance provider’s website which allows me to look up facilities and estimated cost for predefined procedures. I find most providers are listed with a $400-$500 estimated cost.
I book an appointment with one of these providers and have my doctor send the order there.
The administrator at this provider tells me that if she bills my insurance, there will be a high cost, but if I pay directly it will be about $500. I book the appointment.
I call my insurance to change the facility on the authorization. They tell me my estimated OOP is about $340. I ask if this takes into account my deductible. They say “yes” but then stress that this is “only an estimate”.
I’m at my wit’s end at this point. I have an actual procedure code at an actual facility. It’s a pre-defined procedure. Everyone knows exactly what’s going to happen but no one can give me confidence abotu what I’m going to have to pay.
The provider just says “pay us $500, don’t go through your insurance”. Insurance says “don’t do that because you want this applied to your deductible and we have better negotiated rates” but they can’t guarantee a price.
Do I just go through with it and have them file the claim and hope for the best?
submitted by /u/mmchicago
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(United states health insurance question) TL;DR I have an estimated cost and a pre-authorization for a CT scan from my insurance provider but I don’t trust it based on what I’ve heard from the provider. CT scan provider says my OOP will be very high and I just just pay the direct (no-insurance cost). Insurance estimate says the fee will be reasonable. Who do I trust? —– This is really driving my crazy. My doctor orders a CT scan of my pelvis and abdomen. His office per-authorizes it with my insurance and sends the order to the facility he’s affiliated with. I do my own research and find that this should cost me between $500-$1000. The facility calls me prior to the appointment and tells me my OOP responsibility is $2800 and they ask for my credit card on the spot. (I have a $5k deductible). I cancel the appointment. I go to my insurance provider’s website which allows me to look up facilities and estimated cost for predefined procedures. I find most providers are listed with a $400-$500 estimated cost. I book an appointment with one of these providers and have my doctor send the order there. The administrator at this provider tells me that if she bills my insurance, there will be a high cost, but if I pay directly it will be about $500. I book the appointment. I call my insurance to change the facility on the authorization. They tell me my estimated OOP is about $340. I ask if this takes into account my deductible. They say “yes” but then stress that this is “only an estimate”. I’m at my wit’s end at this point. I have an actual procedure code at an actual facility. It’s a pre-defined procedure. Everyone knows exactly what’s going to happen but no one can give me confidence abotu what I’m going to have to pay. The provider just says “pay us $500, don’t go through your insurance”. Insurance says “don’t do that because you want this applied to your deductible and we have better negotiated rates” but they can’t guarantee a price. Do I just go through with it and have them file the claim and hope for the best?
submitted by /u/mmchicago [link] [comments]Read Morer/HealthInsurance