Is ins co liable for extra costs if I pay?

[mmarsh]

I have a PPO! I was and was not surprised by the information. It's seems as though these days they deny until you're dead or just go away. Unfortunately the state (CA) office of ins is no help either as to date they have never overturned an ins co regarding ADR. I found 2 docs who dissented in almost 80 cases. Made my head spin! What use is the FDA if not to guide consumers and ins cos as to what is available! It seems that as cos become more and more cost concious, RE meds and procedures, we are in serious trouble! It's not like ins coverage is cheap, either!

OK, there's my rant!

Missy

[Maria]

You would think I was overinsured by the sound of it but it's amazing just what isn't covered..

[nomorepain]

After a major spine surgery like ADR it's amazing to find out just what is covered and what is not! My ADR surgery was approved by my PPO, and i called in to find out what i might expect to pay, i was told before surgery it would be my deductable of $2,800 + $1,000 period! i thought! it was not explained that in a procedure like this there are many procedures and doctors and corporations not on the PPO list, like i had a choice , i was under general anastisia(my spelling is wrong), there were 3 surgeons, a vascular, not covered by my PPO, and a third in case my ortho or the vascular couldn't finish, he wasn't in the PPo list either, and they are not there free, all the little incidentals, like a CT scan after surgery, wasn't pre-approved& cost a bundle(but i was not told this prior) my out of pocket was just over $50K

[sahuaro]

nomorepain:
You certainly had quite an out-of-pocket expense for something that was "covered." I think your experience provides really important information for those considering surgery in terms of asking very specific questions about who
all the surgeons will be, what additional charges will be involved, and radiological studies post-surgery.

[ans]

Important topic - thanks. I spoke to Maya at Dr. Regan's office a few days ago. Only two insurance companies will pay so it'll be a Laurie Todd research/fighting game therefore.

[dshobbies]

Though I ended up in Germany, both Dr. R and D told me that neither accepted the limits of insurance and I would be expected to pay the difference. Until now I assumed all other doctors would be covered. Stupid me!

[ans]

D: You did the right thing and I hope your huge surgery was successful.

ans