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JenniferO
I am in the pre-surgery mode of searching for the right surgeon for a hoped mitral valve repair in the very near future. I have a primary health insurance policy with United Healthcare of Utah in which I am for all practical purposes limited to one hospital and one surgeon of the caliber needed to attempt mitral valve repair. This particular surgeon can only give me a 50-75% chance of repair, so I am shopping outside of network for better odds. My diagnostic films have been sent to Cosgrove at Cleveland Clinic and to Dr. Lawrence Cohn at Brigham and Womens Hospital in Boston.
I am wondering if anyone has dealt with the out-of-network insurance problem. My policy provides for some out-of-network benefits at 70% of the UCR allowance, leaving me to pay 30% of the UCR up to an out-of-pocket maximum of $3,000. HOWEVER, the SCARY part to me is that the policy also states that in addition to my 30% copay, I am further financially responsible for the "gap" between the total charges and the UCR (i.e. those disallowed charges that are normally written off by the provider when you are IN-network). The financial counselor for Dr. Cosgrove at Cleveland Clinic has confirmed for me that my understanding is correct. I am a person of very average means and the thought of ending up with a $20,000 or more bill for the surgery is really keeping me up nights.
I have been able to pick up secondary health insurance coverage during the most recent "open enrollment" period with Blue Cross/Blue Shield as a dependent on my husband's insurance through his employment. I am also told by the CCF financial counselor that she cannot tell me if this will help or not.
Any one had experiences that might help me understand what to expect?
There are days of despair I think I should just forget trying to better my odds and stick with the in-network hospital, although that well may be the difference between a valve repair and a valve replacement.
Jennifer Olson
I am wondering if anyone has dealt with the out-of-network insurance problem. My policy provides for some out-of-network benefits at 70% of the UCR allowance, leaving me to pay 30% of the UCR up to an out-of-pocket maximum of $3,000. HOWEVER, the SCARY part to me is that the policy also states that in addition to my 30% copay, I am further financially responsible for the "gap" between the total charges and the UCR (i.e. those disallowed charges that are normally written off by the provider when you are IN-network). The financial counselor for Dr. Cosgrove at Cleveland Clinic has confirmed for me that my understanding is correct. I am a person of very average means and the thought of ending up with a $20,000 or more bill for the surgery is really keeping me up nights.
I have been able to pick up secondary health insurance coverage during the most recent "open enrollment" period with Blue Cross/Blue Shield as a dependent on my husband's insurance through his employment. I am also told by the CCF financial counselor that she cannot tell me if this will help or not.
Any one had experiences that might help me understand what to expect?
There are days of despair I think I should just forget trying to better my odds and stick with the in-network hospital, although that well may be the difference between a valve repair and a valve replacement.
Jennifer Olson