Insurance... Insurance... Insurance...

 

Bills, Bills, Bills... Right?

What would one expect after having three major procedures performed during surgery.

I just want to take the time to say how very blessed I am for my work insurance, but holy jesus, is medical care over priced in America!

I am so grateful that I have such spectacular coverage through United Health Care and that they are covering the majority of my health care costs, otherwise I would be BROKE and IN DEBT for the majority of my life!

Before I give the breakdown of what my total surgery costs were, and who covered what I just want to make it known what my coverage is:

I pay $70.00 a month for United Health Care for their Choice Plus, Apple Plus Health Plan.

I also pay $106.70 a month through Medicare/Tricare which is my monthly premium, and that covers me for Medicare A, B and D. 

 UHC is my primary. Medicare/Tricare is my secondary.

The way that it works is they bill UHC through my work first, and then whatever is not covered they bill Medicare/Tricare.

Through Medicare/Tricare because I live in the state of Ohio, Anyone who is eligible for disability due to health issues, or prior service military or qualified through the US Government as a Disabled Veteran automatically gets Medicaid as well. 

In the state of Ohio, they combine Medicare/Tricare and Medicaid into one plan. That means if you are eligible for any Medicaid Plans at all, and you have any Medicare plan, whether just Medicare or you are apart of your disability, or like me, Medicare/Tricare, than effective February 2015, you were automatically enrolled in MyCare Ohio, who manages both your plans.

So essentially, I have three coverages. But realistically, for billing, only have two.

I have UHC, and then I have MyCare Ohio. MyCare Ohio manages my disability Medicaid and my Medicare/Tricare coverage.

Next Step... Claims...

So basically, one would wonder what surgery costs me through my really good coverage through UHC and Medicare through Northside Hospital and Dr Sinervo at the Center for Endometriosis Care.

I'll give a breakdown:

Northside Hospital:

Here, you see that my deductible for IN NETWORK is $300.00 and my OUT OF NETWORK is $600.00 of which I have $300.00 remaining to pay. You also see that my OUT OF POCKET MAXIMUM is $4,000.00. What does all this mean?

Well, if you go through an IN NETWORK provider, before they cover you 100% for care, you have to meet a $300.00 deductible, and then they cover you 100%. the same goes for OUT OF NETWORK except it is $600.00

The $4,000 out of pocket maximum also means that the most I would pay out of pocket is $4,000 for medical expenses. As you can see, I've already paid $540.00 this year. Typically this accounts for prescription RX, copays, and deductibles as well as medical bills.

Northside Hospital is IN NETWORK. 

When Northside Hospital billed, they billed $33,488.50 which broke down to the following:

And So I login to MyUHC Portal to see what all was covered:

My UHC Insurance covered ALL but $300.00 towards my two day hospital stay.

I would typically owe $500.00 which would include a $200.00 inpatient admission charge, but it appears that MyCare Ohio, which is my Medicare/Tricare coverage covered the $200.00 inpatient admission charge, leaving me my $300.00 deductible to pay. Not bad at all. I'd much rather pay $300.00 over $33,488.50 any day.

Center for Endometriosis Care / Dr Sinervo

As previously stated, the CEC is OUT OF NETWORK

So how exactly does this work?

Well, today, I spoke to Dr Sinervo's biller.

She said as follows:

The max that they bill for insurance is $16,700. That is the total cost of my surgery. 

She explained that my maximum that I could possibly owe is $10,000, and that they would write off the $6,700.00 and that my insurance will cover 70% of the $10,000. 

So I could only possibly owe them $3,000 from insurance to the CEC.

Thats not accounting for the $700.00 credit I will have, so technically, I will only owe them 2300.00.

Realization:

That seriously is not bad at all, considering the total cost, in network and out of network for my surgery was $16,700 + $33,488.50 totaling $50,188.50  of which I only get stuck paying $2300.00 for since I've already paid $1000.00 to the CEC, which includes a $600.00 deductible ($300 of which I am left to pay, so I have a $300 credit, plus the remaining $400.00)

REAL REALIZATION

The Cost of Healthcare is INSANELY EXPENSIVE in the US! 

So thats pretty much it.