DC – Is there a place to find the “allowed benefit” amount for each procedure?

I am looking to get sinus surgery this month and am having an impossible time figuring out what it will cost me.

I have the CareFirst BluePreferred PPO plan with a $1500 deductible. I am looking to get an adenoidectomy (CPT 42821) and removal of foreign object (CPT 30310). This will be done outpatient under general anesthesia at a hospital. The anesthesia code is unclear to me but seems to be 00160 for about 4.5 units.

I know that both procedures (and the anesthesia) are billed at the allowable cost against the deductible first and then I’m responsible for the copay up to the out of pocket max. BUT, no one will tell me what the allowable cost is? Additionally, there’s a facility fee listed for both surgery and anesthesia in my benefits explanation but is the facility fee applied twice or just once?

Everyone I’ve talked to from CareFirst is acting like I’m pinching pennies and should just submit my claims after the procedure but this is literally the difference between hundreds and thousands and considering that this is elective, I want to be measured.

Any advice would be appreciated!

submitted by /u/The_Empress
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I am looking to get sinus surgery this month and am having an impossible time figuring out what it will cost me. I have the CareFirst BluePreferred PPO plan with a $1500 deductible. I am looking to get an adenoidectomy (CPT 42821) and removal of foreign object (CPT 30310). This will be done outpatient under general anesthesia at a hospital. The anesthesia code is unclear to me but seems to be 00160 for about 4.5 units. I know that both procedures (and the anesthesia) are billed at the allowable cost against the deductible first and then I’m responsible for the copay up to the out of pocket max. BUT, no one will tell me what the allowable cost is? Additionally, there’s a facility fee listed for both surgery and anesthesia in my benefits explanation but is the facility fee applied twice or just once? Everyone I’ve talked to from CareFirst is acting like I’m pinching pennies and should just submit my claims after the procedure but this is literally the difference between hundreds and thousands and considering that this is elective, I want to be measured. Any advice would be appreciated!
submitted by /u/The_Empress [link] [comments]Read Morer/HealthInsurance

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