Scan Medical Insurance

How do you get an estimate up front for medical costs?

My husband needs to have major back surgery in a few weeks. I asked him to ask the doctor's office if they have an estimate from the insurance of what our out-of-pocket costs will be. The response was "Don't you know what your insurance covers?" No, we don't. And if we understood what the insurance covers, we've never heard a word about what the surgeon or hospital will be charging to calculate a percentage "of what." Is this information that the doctor or the insurance should be providing? I'm wondering if I'm the first person who ever asked this sort of question up front by the response we've gotten so far. I'd like to have some idea what to expect and I don't think that is an unreasonable request. Should I essentially demand the surgeon's office come up with some type of estimate or should I be pursuing this through the insurance company? Do I just assume that whatever our annual out-of-pocket maximum is for a year is what it will be? Adam, I meant to vote you as the best answer and clicked the wrong button-the thumbs down- on accident. I'm sorry-I don't know how to undo that.

Public Comments

1. Call your insurance and get the facts from your policy and what it covers and how much. I had back surgery that insurance paid for it was over $50,000
2. No, the doctor should be able to tell you how much the surgery is going to cost. I would demand from them so you can give your insurance company an accurate number so they can tell you what percentage they will cover...
3. Okay, if you are in a typical American managed care plan, you are asking the wrong people about the cost. Ask the doctor what services they expect to bill to the insurance company (not cost). Then, call your insurance company to find out what the negotiated price is for those services. My guess is, your doctor's office doesn't know what your HMO discounted rate is. Your doctor can answer with what they will try to bill the insurance company for. However, the managed care plan won't pay that - they will pay the negotiated rate. Then, make sure that everyone involved in the surgery is part of your network. This means the doctor, the facility, the radiologist, the anesthesiologist, and anyone doing labwork. If someone is out-of-network, you will pay more in PPO plans, and pay everything in HMO plans. -->Adam
4. call your insurer and give them the policy number, they should be able to advice you on the coverage amount and benefits call your doctor ask for the fees. If there is any shorfall, please prepare the difference in advance.