D&C Insurance - so confused

ginnyreece · June 2014

I had a D&C procedure done because I was losing so much blood, and after my insurance pays, I'm ending up having to pay about $1,300 after meeting my deductible. I was put under full twilight anesthesia in the hospital where my doctor performed the procedure. However, I am getting billed by many different providers. (My doctor, the hospital, the anesthesiologist, and diagnostics). My insurance covers 90% of this because they consider it "urgent" vs. "routine." But, because they are all different providers, the bills are stockpiling.

Can anyone tell me if this is normal? There's nothing worse then having a miscarriage then getting to pay for it.

tlc35 · June 2014

It does add insult to injury, doesn't it? I think mine ended up costing us about $2300. I'm sorry for your loss.

stephy1221 · June 2014

Yes, I received separate bills from the different providers. I ended ended up with about $1200 in bills.

Sparkle519 · June 2014

If the doctors were out of network u can try to fight it but if they were nj network and that's your benefit coverage than unfortunately your stuck. U can always try to work out payment plan too. Lmk if u have any questions

meredithcarole · June 2014

I am sorry you are feeling the financial pain of this as well. I have a high deductible plan ($3k). I have spent $4500 out of pocket. Sadly it the norm - each individual doctor bills for their own services. Deductible plus copayment and there you go, lots of money out the door.

jennadesigns · June 2014

I'm sorry for your loss. And I'm sorry you're dealing with insurance issues ... it's so disheartening on top of everything else you're going through. I had my D&C four weeks ago and the insurance bills are just rolling in ... looks like I'm going to pay about $1,300 out of pocket and I have good insurance that covers at 80 percent. I know I personally wanted to cry when I got the bill. Hugs to you.

AggieBeth06 · June 2014

Call your insurance and ask for an explanation of benefits to be mailed or e-mailed to you. It is confusing, but you need to know that your benefits have been properly applied before you pay a dime. Do not be surprised when the people you call in the medical and insurance offices are less than helpful. Often they only have access to part of the story. I have found this to be true repeatedly.

Usually how it works is that you have a deductible, co insurance and an out of pocket max. Doctors/hospitals are either in your network or they aren't. You usually have a deductible, co-insurance and an out of pocket max for in-network providers and a second set for out of network providers.

Anesthesiologists and ambulances are usually out of network or not covered, which is where things get really confusing.

I have a $1500 deductible and $4500 out of pocket max for in network providers. This means that for the first $1500 of medical bills, I have to pay 100% of their contracted rate. Sometimes your office co-pays count and sometimes they don't depending on your insurance.

After I pay the $1500 deductible, my coinsurance kicks in... which means that insurance pays 80% of the bill and I pay 20% (each plan is different on the breakdown of percentages - check your coverage). I pay 20% of all in-network bills at their contracted rate for the next $3000 (out of pocket max of $4500 = $1500 deductible + $3000 coinsurance for me).

If you go to a provider who is out of your network or isn't covered, then that's another kettle of fish...Like my genetic testing and ambulance ride which cost me $2000 and doesn't apply to my out of pocket max... I loathe insurance sometimes. It is crazy. It adds insult to injury.

(((hugs)))

kath16 · June 2014

I know this doesn't help the OP but I wanted to provide a different prospective for anyone else who might be reading

My D&C was done in my OB's office. So all I have to pay is my usual specialist copay and then some miscellaneous percentages of certain things that count toward my deductible. Like, for some reason my insurance covers all but $5.88 of one of the lab tests for some reason.

At the moment my total out of pocket is about $140 (40 copay for the procedure and maybe another 100 total for the random ultrasound and test costs).

Just thought that may help for those who do (or have the option to) have the procedure done in a doctor's office rather than a hospital. NOT EVERY DOCTOR OFFERS THIS

summerbld2 · June 2014

We will end up paying about $5k oop. The whole bill for our D&E has been 10k. So expensive.....esp since we didn't get a sweet baby out of it.

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