8:00 AM Conversation with Blue Shield

Luckily, the representative that I talked to on the phone seemed knowledgeable. 

 

Even more luckily, Stanford Hospital is in network, which means for my hospital stay my co-pay is only 10%, and there's no daily maximum.  If it were out of network, it'd be 30%, with the daily allowable amount of total charges capping out at $600.

 

Not so lucky?  These numbers:

 

Procedure                          Surgeon's Quote          Blue Shield's Allowable Amount (they pay 70% of these)

Maxillary Osteotomy           $16,800                       $1,636 (not even 10%!)

Mandibular Osteotomy         $16,800                      $1,784

 

Blue Shield says I'm responsible for the difference, because my surgeon is out of network.  Whoa.

 

Why don't they just go by their initials - BS.

Insurance

Oh no.  Received a letter from my surgeon's office that said my insurance would only cover 15% to 30% of what's considered usual and customary charges.  Considering my doctor is out of network, that would be a HEFTY bill.  I have to call Blue Shield tomorrow to see if my copay maximum applies in this case.