Cysto/Hydro Friday...Anyone Else Out-of-Network?

[jameson77]

Wondering if anyone here has been an out-of-network patient for their IC Specialist or their IC procedures?

Less than two days from my cysto/hydro/biopsy and was just told that i will have to pay $$$ before the procedure is done, as if i am not nervous enough. My insurance only pays 50% after my deductible is met, but i do have out-of-network coverage...and there is no one anywhere near me that specializes.

This whole dx road has been long and frustrating...i believe i would like to describe it as medical and financial hell. I am still paying off an ER visit in September due to severe IC pain.

I just needed to vent for a few moments, since i am near meltdown mode!!! Any experiences will be greatly appreciated right about now. :loco:

Just needing some support!

Meredith

[dg2901]

My insurance will only pay out of network if its an emergency and I'm nowhere near a participating hospital.

[Briza]

Yes, my former uro who did my cysto/hydro/biopsy was out of network....so higher deductible and when deductible was met I had to pay 50% for out of network uro. Other than the VERY expensive cash up front ($450-$750 a visit) office visits pre-hydro, the uro's charge for the surgery was only about $750....but that was only HER charge for the surgery...there of course were also the hosptial bills for pre-op appt, OR room, the anesthesiologist, etc....luckily all of those were IN network as I had complications and a weeks hospital stay after my hydro....didn't cost me too much on THAT part b/c once I met my lower deductible and out of pocket for in network expenses most everything was covered 100%....except for my private hospital room....which apparently I was given b/c I was in so much pain and screaming and crying 24 hrs a day for a week no one else could be roomed with me!! :rolleyes:but even then I only had to pay extra $600 additional for week for private room. But it was the complications and the visits of my out of network dr twice a day while I was in hospital that week that ran up my bill...ugghhh...and of course much missed work and very little on my paycheck that month:( SO I had like $7000 bill with the uro at the end of it all, that was just for the surgery and her hospital visits am and pm...
Obviously I was NOT happy b/c I felt and to this day still feel it was her fault I ended up in hospital for a week and her huge bills out of the wazoo coming at me every month. Bills her office sent me were confusing and did not show what I had paid past month and how it was deducted....I was very confused and called her office manager and said all I want is one bill a month showing what I paid last month and what I owe...Office manager said that is not possible b/c you are paying for this service and that service provided by uro at different times. Totally confused me and I said, hey, I have been sending you close to $500/month to pay this uro's bill off, but if you cannot send me a billing statement that I can understand y'all are only going to get $10 a month from me. I hated to do that b/c I like to pay my bills promptly and as quickly as possible. Just so happened that I had been in an ACT OF GOD no fault auto accident and so I had an atty and I had the medical secretary for hte atty call and ask/demand that I get a discount on what I owed the uro...even tho it was not related....but uro did not know the details so for all she knew possibly she thought I was in position to sue her for malpractice (which I never planned to do but had atty so figured why not have atty's med sec call and see what kind of discount I could get??!!) Anyway, I got I thin 38% discount for what I owed uro if I paid up full and clear right then, which I did, because I was not going to have another opportunity like that.

Anyway, moral of story is, if you have many and some large medical bills that need to be paid off whether or not they have been sent to collections or not (which they shouldn't if you are paying at least something every month) but regardless, you can wheel and deal with drs and collection agencies if need be....and more likely to get very good deal to pay off bills if you are only sending a small amount every month....If you are sending large amount every month they figure you will continue to do so and get it paid off fast, but if you send small amount every month, like when I told uro if I don't get a monthly billing statement that IIIIIIIIII can understand, well then you are not going to get $500 a month, more like $10 a month, then they are more likely to settle for charges at LEAST 25-30% off what you owe if you can pay that all at once. They want most money they can get in the fastest time possible, we want to get bills paid and settled cheapest we can. You don't need an attorney to do this...you can wheel and deal with the bill collectors yourself and it most times works to patients benefit, I just happened to have an atty on retainer at the time.

[mary124]

My insurance will only pay for out of network if and I mean only if there is no one in a reasonable area. Luckily for me though all of my doctors/providers are in network.
Just a few weeks ago I had my first hydro for the year so I had to pay the 20% of my deductable plus a $100 dollar co-pay and whatever else is with this. After i meet my deductable I will only pay the $100 co-pay and nothing else for the procedure.

[jameson77]

Yes, my former uro who did my cysto/hydro/biopsy was out of network....so higher deductible and when deductible was met I had to pay 50% for out of network uro. Other than the VERY expensive cash up front ($450-$750 a visit) office visits pre-hydro, the uro's charge for the surgery was only about $750....but that was only HER charge for the surgery...there of course were also the hosptial bills for pre-op appt, OR room, the anesthesiologist, etc....luckily all of those were IN network as I had complications and a weeks hospital stay after my hydro....didn't cost me too much on THAT part b/c once I met my lower deductible and out of pocket for in network expenses most everything was covered 100%....except for my private hospital room....which apparently I was given b/c I was in so much pain and screaming and crying 24 hrs a day for a week no one else could be roomed with me!! :rolleyes:but even then I only had to pay extra $600 additional for week for private room. But it was the complications and the visits of my out of network dr twice a day while I was in hospital that week that ran up my bill...ugghhh...and of course much missed work and very little on my paycheck that month:( SO I had like $7000 bill with the uro at the end of it all, that was just for the surgery and her hospital visits am and pm...
Obviously I was NOT happy b/c I felt and to this day still feel it was her fault I ended up in hospital for a week and her huge bills out of the wazoo coming at me every month. Bills her office sent me were confusing and did not show what I had paid past month and how it was deducted....I was very confused and called her office manager and said all I want is one bill a month showing what I paid last month and what I owe...Office manager said that is not possible b/c you are paying for this service and that service provided by uro at different times. Totally confused me and I said, hey, I have been sending you close to $500/month to pay this uro's bill off, but if you cannot send me a billing statement that I can understand y'all are only going to get $10 a month from me. I hated to do that b/c I like to pay my bills promptly and as quickly as possible. Just so happened that I had been in an ACT OF GOD no fault auto accident and so I had an atty and I had the medical secretary for hte atty call and ask/demand that I get a discount on what I owed the uro...even tho it was not related....but uro did not know the details so for all she knew possibly she thought I was in position to sue her for malpractice (which I never planned to do but had atty so figured why not have atty's med sec call and see what kind of discount I could get??!!) Anyway, I got I thin 38% discount for what I owed uro if I paid up full and clear right then, which I did, because I was not going to have another opportunity like that.

Anyway, moral of story is, if you have many and some large medical bills that need to be paid off whether or not they have been sent to collections or not (which they shouldn't if you are paying at least something every month) but regardless, you can wheel and deal with drs and collection agencies if need be....and more likely to get very good deal to pay off bills if you are only sending a small amount every month....If you are sending large amount every month they figure you will continue to do so and get it paid off fast, but if you send small amount every month, like when I told uro if I don't get a monthly billing statement that IIIIIIIIII can understand, well then you are not going to get $500 a month, more like $10 a month, then they are more likely to settle for charges at LEAST 25-30% off what you owe if you can pay that all at once. They want most money they can get in the fastest time possible, we want to get bills paid and settled cheapest we can. You don't need an attorney to do this...you can wheel and deal with the bill collectors yourself and it most times works to patients benefit, I just happened to have an atty on retainer at the time.

......thanks for sharing the experience. you would know the movie "Sicko" came on last night and i happened to watch it, so now i am all fired up about medical coverage! but i know i am lucky to even have it. but it still doesn't make it any more comforting to know i will be hit with more $$$$ medical bills. it's not the patient's fault there are no IC specialists in their network and i am planning to send correspondence to my insurance company regarding this.

[snowgirl]

Wondering if anyone here has been an out-of-network patient for their IC Specialist or their IC procedures?

Less than two days from my cysto/hydro/biopsy and was just told that i will have to pay $$$ before the procedure is done, as if i am not nervous enough. My insurance only pays 50% after my deductible is met, but i do have out-of-network coverage...and there is no one anywhere near me that specializes.

This whole dx road has been long and frustrating...i believe i would like to describe it as medical and financial hell. I am still paying off an ER visit in September due to severe IC pain.

I just needed to vent for a few moments, since i am near meltdown mode!!! Any experiences will be greatly appreciated right about now. :loco:

Just needing some support!

Meredith
Ihave gone out of network for 23 years for uro and gyn. All md's write letter then it goes to insurance md for approval or denial. Only once when my employer changed carriers they gaveme a hard time . I thought I was going to have to get an attorney. My hospital HR team and my union got my out of network back and approved for 21 years that I worked there. VN

[snowgirl]

Letter written to insurance co for out of network. Reason like you it is not treated her in my town and I am too advanced if it was. I had letters written to insurance md by uro, gyn and family md and then they had all my records.
More md to write why you must go out of network I think the better myself. Vn

[jameson77]

thanks ladies. i have done nothing at work but deal with insurance stuff for tomorrow, and i have so much work to do.

i had a mini meltdown in my office...i thought everyone was gone but some random person just busted me with tears streaming down my face. this has just been way too much to deal with, on top of my nervousness about tomorrow. i am contemplating leaving work early, my nerves are so shot. :bonk:

i mean...all i want is to feel better.

[jen74]

I am sorry you are dealing with all this stress right now. Did they tell you exactly how much you are going to owe in total after the procedure? You should call the hospital and ask. I had just a regular cystoscopy with biopsies( But NO hydro) done . I was sickened by how much they charged me. It was well over $6000. It was in network for me and I still got a bill for over $1,300 that they wanted me to pay after my insurnace covered what it covered. There is one thing you can do though. If you are not going to be able to pay the high bill, you can call the hospital and ask if they have a charity center. When I got my bill for the 1,300, I called and told the billing dept.that I could only pay about $40 bucks a month. They said no, that it was not acceptable. I could not believe my ears, they refused to take my money unless it was at least 125 bucks per payment. I then called around the hospital and they said to call the charity center. I did. I sent in all my bills I have to pay monthly and explained to them that I was more than happy to pay my bill, but only could pay so much per month. They wrote me back saying that I would only have to pay $400 of that bill. So I pay like $47 a month until I pay it off.
It really is sick how the medical profession is allowed to legally rob us like this. Now I know the procedure is worth at most maybe $1000, and that is even pushing it. For what my doctor did, I would say maybe $600. It is a complete joke how they rip people and insurance companies off. We wonder why the insurnace companies do not want to cover people, well it is because of the doctors and their outlandish prices. I hope to God that one day our country can finally put it's people on the top of the list with health care, FREE health care that is. That is the way it should be!!
I hope all goes well with your procedure tomorrow. Good luck.
Jen

[jameson77]

So, i had my cysto/hydro/biopsy and the results are as suspected...IC. I feel so validated today. Two years of endless doctors, meds, $$$, needless tests, and finally i have my answer.

The procedure was positive for me. I was given Marcaine Kenalog and Marcaine Pyridium which totally helped the exruciating burning pain when i went to the bathroom for the first several times (for anyone pondering or scheduling this, i would highly recommend it). I had to stay at the hospital longer than i expected because i had a hard time going to pee. But, finally i went and was discharged. Dr. Evans was absolutely wonderful and took the time to talk to my hubby and i before, and also talked to my hubby and parents while i was in recovery. He sent me home with pictures that confirmed my poor little bleeding bladder. He was able to distend me to 800cc. At my prior awake in-office cystoscopy (two years ago that documented red, patchy inflammation that i recently read), i was only able to be distended to 350cc due to severe pain.

Here it is, 11:35pm and i am still finding relief from the Marcaine. However, i am having major frequency, some burning (for now) and bladder soreness/pain that wasn't present before. But i am taking my pain meds and other meds that are helping me. My annoying and constant low back pain is completely gone right now. However, I am wondering if tomorrow morning will be a different story.

I just wanted to post my experience for others, which has been positive. The nurse and doctor told me that i may feel bad for the next couple days, up to a week, but i am prepared to handle it. I feel like a weight has been lifted off of my shoulders, especially to know that i haven't been crazy all this time...something has been wrong. I am hopeful for the future and have my follow up appointment in three weeks, when i will begin my plan of care with Dr. Evans. I feel a little foolish about my insurance rant...but it was just too much to handle the day before surgery when all of these thoughts were going through my head. My hubby has been absolutely wonderful, and i am blessed to have him, along with my supportive family.

I just wanted to give an update about my experience, and if anyone is scheduling this, please feel free to PM me and i will be happy to talk to you! I want to give a special thanks to Briza, sickofmybladder, and the other gals for talking me under their wing, and walking me through this...your support has truly meant a lot! God bless you all, and if you ever need anything, i am here!!!! :pray: :pray: :pray:

XOXO,
Meredith

PS---i received my Intersitial Cystitis Survival Handbook and haven't been able to put it down!

[ICNDonna]

I'm so glad it went well for you.

Warm healing thoughts,
Donna

[smsaz620]

I am having this procedure in a few days.
I am not sure what it entails...can you share with me more? what they did?
my dr. wants to do nerve severing too...
how long is your recovery time? did they give you different meds afterwards? where you put to sleep?
will you still have to have weekly/monthly installations? i currently go weekly for one so i am not sure what happens after surgery. thank you for answering all my questions, i am new here and overwhelmed and want to know what to expect!
shannon

[jameson77]

I am having this procedure in a few days.
I am not sure what it entails...can you share with me more? what they did?
my dr. wants to do nerve severing too...
how long is your recovery time? did they give you different meds afterwards? where you put to sleep?
will you still have to have weekly/monthly installations? i currently go weekly for one so i am not sure what happens after surgery. thank you for answering all my questions, i am new here and overwhelmed and want to know what to expect!
shannon

....Shannon, i just PM'd you. I am not sure about nerve severing...i am sure someone will chime in. I go back for my follow up appointment in three weeks and he said we would discuss me doing home instillations, which i am all for if it gives me the relief i have already experienced with it, and since i am about 1.5 hours from his office. As for recovery time, i believe everyone is different...my doc said i would start to feel better by the end of this week.