Hello guys 
,
I have a surgery scheduled in the next few weeks. I have already met my deductible, and per my insurance, I then have a coinsurance of 10%. The hospital gave me an estimate of what I owe them for the surgery as $1441, which is the remaining balance of my OOP max, which is $4000. However, my surgeons office called me and stated it appeared that I would owe them $552. However, if I pay both of these amounts this would put me over my OOP max by $552. Is there a way to communicate this to the hospital and/or surgeons office so that I don’t have to exceed my out of pocket max? Neither of these amounts are showing as like charged towards my OOP max since I haven’t had surgery yet so I don’t know how to have them communicate properly with my insurance so that I don’t have to exceed my OOP max. TIA!
Are they asking you to prepay for their services? Let them know you’d prefer to wait for the insurance company to process the claims because of the OOP situation. This way, you won’t have to chase down a refund later. You can also call your insurance for guidance on what to do.
The surgeons office is requiring the amount be paid 6 days before surgery. I’m not sure about if the hospital would accept a partial payment.
Pay the surgeon and the hospital whatever is left of your OOP max. Let the hospital know you have pending claims and will pay any remaining balance after getting your EOB.
It’s much easier to wait and pay if they allow it, rather than dealing with a refund. You would get a refund, but it might be a hassle and take a long time.
Push back and say you won’t prepay because your insurance will cover almost everything. Providers push for prepayment because they’re worried patients might not pay after treatment. While I understand, I still think it’s not right. I work in insurance and always refuse to prepay for any procedure because it’s a hassle to get your money back later.
We require minors to have a credit card on file from the guarantor because there have been cases where a minor was dropped off with no way to pay the copay. Months later, the guarantor disputes a $900 bill, claiming they don’t owe it. We give non-minors the option to either provide a card on file or pay at the time of service. If I see that their coverage is close to meeting their OOP, I inform billing that they prefer to receive a statement once processed to see their remaining balance. Some patients just prefer statements. If they’re past patients or owe a lot per visit, I may require a card on file as a backup in case they try to avoid payment later.
Since your surgery hasn’t happened yet and no bills have been submitted, you haven’t met the OOP max. The estimates they’re getting right now don’t account for each other. If you pay both now, you’ll be owed a refund from whichever claim processes second. Unless there’s a discount for prepaying, it’s better to wait for insurance to pay.