You already got my leg, you want my arm too?
May 6, 2010 9:36 AM Subscribe
I'm scheduled for major surgery. Fortunately, I have insurance. Unfortunately, I don't understand it. What's this really going to cost me? What does it mean for my other medical expenses for the rest of the year, both routine and emergency?
posted by acorncup to Work & Money (10 answers total) 1 user marked this as a favorite
The deductible is $500. The out of pocket maximum is $3000. There are copays, like $50 for each PT visit, $50 for each specialist visit, $30 to see my GP. A whole bunch of services are listed at 20% on the Summary of Benefits.
I expect bills from: the surgeon; the anesthesiologist; the hospital; the hospital doctor; physical therapy in hospital, at home, and later at their location; occupational therapy in hospital and possibly also at home; nurse visits at home. All of these are in network. I expect the total bills to be somewhere around $70,000, but the amount that Anthem pays and that the providers accept as full payment will be considerably less than that.
Once I leave the hospital, when I've met the $3000 out of pocket maximum, if I need to see the physical therapist at their office, do I have to pay the $50 copay each time I darken their door? What about when I see the surgeon 6 weeks post-op - do I have to pay him another $50 copay? What about later in the year when I see my endocrinologist about unrelated issues, do I pay him $50 for every visit? What if the other hip gives out and I need another surgery - is that free if it happens in 2010? Am I well and truly done paying for doctors in 2010? Are there any other financial surprises lurking around the corner? What else do I need to know?
This is in Kentucky. The insurance is Anthem. I try to google and I get definitions but no big picture explanation.