, , ,

So I got the statement from the hospital for my hip-replacement┬ásurgery and 4-day hospital stay. Without the negotiated insurance price, the number was $63,349.27. This doesn’t include surgeon’s fees, pathologists, etc. After the negotiated insurance price, it’s $40,454.72. Theoretically, I should owe somewhere in the $3K neighborhood.

However, I got a benefits statement from the insurance company for the pathologist. It indicated that I had only met $72 or so of something called “in-hospital deductible”. I’ve been having problems for months trying to figure out how much of my deductible I had met. The EOB (explanation of benefits) from the insurance company didn’t always show it, and sometimes it conflicted. I’d call and I’d get a different answer each time. I thought I had a $1500 deductible, then I was told I had a $1500 deductible for BOTH in-network and out-of-network providers. Now this “in-hospital” deductible showed up, so I called yet again.

Turns out that I only have one $1500 deductible for everything — in-network, out-of-network, everything. However, the system has been applying charges to these other imaginary deductibles, which means I’ve been paying the difference. I have been assured that Blue Cross/Blue Shield will get all of my claims reviewed and reprocessed in the next few days, but what a scary thing. With a $63K hospital bill staring me in the face, the last thing I need is a screw up with the insurance company. When this gets all settled, I’m going to ask for an accounting of all my claims — what was applied toward the deductible, what was paid to the provider and what I should be liable for. I can’t believe that I am the only insured person this has happened to and I wonder if there’s not an insurance board or some one that ought to be providing some oversight. I’m always cautious about being a whistle-blower, though, so we’ll see how BCBS handles this situation. The good news is that I probably will get at least $1500 back because I’ve met my imaginary “out-of-network” deductible.

On another subject, I took my 7th dose of MTX last night. As usual, slept like a baby. I didn’t get the headache, but my stomach was a little queasy this morning when I woke up. Might have been the XXTravaganza Pizza I ordered last night since I didn’t feel like eating leftovers or any of my homemade soups.

Thanks for checking in.