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NYC Surgeon Bills....questions

lynettellynette Posts: 217
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
I got my last EOB"s in the mail today for both the surgeons in NYC(out of network). BC/BS paid the billing in full!! I went to all the work to get letters stating that they would accept what BC/BS paid them and there was no balance.

spine surgeon anterior portion $89,000
posterior portion $66,000
vascular surgeon $19,500

Does anyone else think thats odd that they paid the full amount?? I asked the women at the billing office today at the vascular surgeons office if that was common and she said no they usually pay 70% of the bill. Just thought it was interesting. Lynette


  • that's great Lynette - I have Blue Cross/Blue Shield also & they were so wonderful & generous with me, my surgery was $325,000 & they assigned a case manager to help me keep track of all the so many different medical expenses that I had. I was so careful to stay in network, I was lucky though, my surgery was in my own city - but it can be so confusing, especially when you aren't thinking that clearly & feel such pain.

    Sounds like you had a great experience with your ins.
  • It's always nice to be surprised in the positive way by your insurance company! Some of the good ones still pay 100% for major surgeries, mine does still, thank heavens! Just for the facilities, the bill for my 2 level ACDF was mind-boggling! I can't remember the exact number, but I was really glad I was sitting down when I looked at the bill, and even happier that the insurance covered the entire thing :))( Sometimes you're the windshield, sometimes you're the bug!
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  • I didn't even ask, how are you feeling at this point? I see you're about 2 months out, how are things going for you? Hope you're doing well!
  • Maybe they only billed the correct amount that they knew the insurance company had agreed to pay. The amounts are almost always known before a surgery is done. If something unexpected comes up that becomes another issue. By the way I had a surgery just like yours but mine was a revision and included more work by the surgeon and time in the hospital and my bills are coming in at about 1/3 less then amounts you have posted. Go figure.

    Good luck.

  • SpineAZSpineAZ WiscPosts: 1,084
    Most likely they billed the "contracted" amount that is in the contract between the doctors/providers and BCBS (as David said). There may be behind the scenes stuff you don't see (like "billed amount", then "contract amount", then "amount paid" which equals contract amount).

    It also depends on your insurance. I have a $1500 deductible per year. So after the first $1500 I only pay co-pays at doctor visits. So my insurance paid my entire hospital bill as I had already exhausted my deductible.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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  • jlrfryejjlrfrye ohioPosts: 1,111
    I agree with the others. The surgeon billed the allowed amount.
  • Hi Lynette,

    Very good news as I recall you had major concerns regarding insurance coverage prior to the surgery. I have Empire BC for hospital, only had to pay $300 deductible for all costs associated w/ my surgery. I'm w/ the others, either they only billed what was allowed or negotiated separately w/ the insurance co. Has to be a relief knowing you'll not have to worry about covering the gap.

  • I am doing really well. I actually returned to work today full time. I walk 2 miles every other day. I will have to cut that back till I get used to the work routine. I was pretty tired. lynette
  • That is amazing! Back to work fulltime already.
    Hope it all goes well and that you quickly develop the stamina to cope with it.
    It must feel great to be getting back to your normal life :-)
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