I was just wondering how people's various insurance carriers dealt with BP clinics/surgeries. We are having some problems with our insurance. Our insurance is Western Mutual, and we were scheduled to have surgery in TX by Dr Nath. Thanks.
~Jessica
Experience w/Insurance Carriers
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cbe411
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- Injury Description, Date, extent, surgical intervention etc: MVA in 2001, nerve graph in 2002, Median Nerve Transfer in 2004 and an unsuccessful Gracillis Muscle Transfer in 2006. I am living life and loving it! Feel free to contact me :)
- Location: Grosse Pointe Woods, MI
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Re: Experience w/Insurance Carriers
Hey I do not have insurnce through then but I do have BC/BS and have had to fight for surgery with Dr. Nath. I just learned a few days ago that they are going to pay about 80% of my bill! I had to write two appeal letters and call all the time! The only advice I can give is to fight them all the way! Make them pay! Let me know if you need any help with appeal letters or anything!
COurt xo
COurt xo
Re: Experience w/Insurance Carriers
Here's what I can tell you about Mayo & my insurance. We have Blue Cross Blue Shield (GA), and they were willing to work with their counterpart (BC/BS-MN) in order to treat all expenses as in-network. I think Mayo is well respected enough that other carriers may have the same arrangement worked out.
We may be wrong in assuming this, but we think the overall costs are lower there because the doctors are actually employees of Mayo instead of in a private practice - thus on a salary. (That certainly should be attractive to insurance carriers, since it's less out of their pockets!)
If it helps, the total charges so far at Mayo (including preliminary tests, 2 operations that lasted over 10 hours each, 3 primary surgeons fully involved the whole time, all the other doctors involved in surgery i.e. anesthesiologist (sp??) etc, 11 days total post-surgery in hospital, four followup visits to Mayo including EMG & other tests )... is $141K. At this point, my total out of pocket has been ~$700, which I think is phenominal considering everything that's been done there - and of which I'm currently appealing ~$650... if I succeed w/that, my total out of pocket would just be $50! btw, this surgery was to transfer 5 functional & 1 sensory nerve over, since all five of John's were avulsed.
Another ubpn poster recently emailed me the following after his Mayo surgery: "Oh, I got the hospital bill from Mayo today and 6 days and two surgeries (one 10 hr) was cheaper than one 1.5 hr surgery and 7 days in Huntsville Hospital. Something isn't right when my local hospital is more expensive than Mayo." His surgery also involved all three: Bishop/Shin/Spinner.
Hope that helps - email me privately if you have other questions.
Ellen
We may be wrong in assuming this, but we think the overall costs are lower there because the doctors are actually employees of Mayo instead of in a private practice - thus on a salary. (That certainly should be attractive to insurance carriers, since it's less out of their pockets!)
If it helps, the total charges so far at Mayo (including preliminary tests, 2 operations that lasted over 10 hours each, 3 primary surgeons fully involved the whole time, all the other doctors involved in surgery i.e. anesthesiologist (sp??) etc, 11 days total post-surgery in hospital, four followup visits to Mayo including EMG & other tests )... is $141K. At this point, my total out of pocket has been ~$700, which I think is phenominal considering everything that's been done there - and of which I'm currently appealing ~$650... if I succeed w/that, my total out of pocket would just be $50! btw, this surgery was to transfer 5 functional & 1 sensory nerve over, since all five of John's were avulsed.
Another ubpn poster recently emailed me the following after his Mayo surgery: "Oh, I got the hospital bill from Mayo today and 6 days and two surgeries (one 10 hr) was cheaper than one 1.5 hr surgery and 7 days in Huntsville Hospital. Something isn't right when my local hospital is more expensive than Mayo." His surgery also involved all three: Bishop/Shin/Spinner.
Hope that helps - email me privately if you have other questions.
Ellen
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Re: Experience w/Insurance Carriers
Ellen.
Perhaps you have written somewhere else, but I am interested in what the results of these surgeries are.
Jo Ellen
Perhaps you have written somewhere else, but I am interested in what the results of these surgeries are.
Jo Ellen
Re: Experience w/Insurance Carriers
John's injury was in Nov '02, & surgeries were in Feb & Apr '03. By summer, he was able to bend his arm, & by fall make a fist. His primary focus now is to build muscle strength, so he can raise his arm against gravity as well as grasp something & move it. (Currently, his arm movement is across a table or in water - i.e. not yet against gravity.) Full recovery won't be known for another couple years.
But already John's pain levels have decreased a good bit, since now when his brain says "move arm", it actually does move. Last summer he was able to cut one pain med in half & stop another completely. He's now working on slowly decreasing the third/final med.
Hope that helps. Email me if you have other questions.
Ellen
But already John's pain levels have decreased a good bit, since now when his brain says "move arm", it actually does move. Last summer he was able to cut one pain med in half & stop another completely. He's now working on slowly decreasing the third/final med.
Hope that helps. Email me if you have other questions.
Ellen