S
SpineAZ
Guest
The best way to figure out the cost is to
(1) Get a copy of the exact policy under which you are covered. Then look for
-Annual out of pocket maximum
-Annual deductible
-Co-insurance % (often 80/20, insurance pays 80% of each bill you pay 20%)
-Co-pays
(2) If you've had medical care this year, your insurer should send you Explanation of Benefits (EOB) after every medical claim. The most recent one will show you how much of the annual deductible you've met and how much of the out of pocket maximum you have met OR sign up with your health insurance to do this online. I do this so I can examine these constantly.
BCBS sells thousanRAB of different insurance plans so there's no way to describe an "average" plan but I can give you an example.
My plan (UnitedHealthCare)
$300 annual deductible. I pay all costs (besides office co-pays) until I reach the $300.
$1500 annual out of pocket maximum
80/20 plan
So for each cost the insurance pays 80% of the cost, I pay 20%
This continues until I reach the $1500.
I had spine surgery in February and thus far have met $1000 of my out of pocket maximum. I'll likely reach it soon thus I am seeking to have any other care I need this year. Essentially I paid $300 deductible and have to pay $1500 out of pocket. Then every treatment after I pay only my office co-pays (I pay $20 for Primary Care physician and $40 for Specialist. However, with surgery he charges me for surgery and the first 3-6 follow ups don't require a $40 fee. So after I pay $1500 this year I pay no more if I have further surgery, am hospitalized, etc.
Every plan year you start over with the deductible, out of pocket max, etc.
Many policy years begin 1/1. Some education policies (for teachers, etc) begin 8/1 or 9/1 of each year. I have a friend here who has a husband that works for the city of Phoenix and their plan begins every year at 10/01.
If you get the exact plan I can walk you through what each thing means.
Oh, almost forgot: Personally I prefer Orthopedic Spine Surgeons but both OSS and NS are capable of doing the surgery on all parts of the spine. My OSS was going to do a ALIF and then his new partner did a Posteriolateral version (relatively new to the industry from what I understand. I had an incision down my back (around 6") and one on my side, above my hip, around 4". The side incision was used to access my spine from the front and to remove the disc between L3-L4 and place a spacer and bone in it's place.
(1) Get a copy of the exact policy under which you are covered. Then look for
-Annual out of pocket maximum
-Annual deductible
-Co-insurance % (often 80/20, insurance pays 80% of each bill you pay 20%)
-Co-pays
(2) If you've had medical care this year, your insurer should send you Explanation of Benefits (EOB) after every medical claim. The most recent one will show you how much of the annual deductible you've met and how much of the out of pocket maximum you have met OR sign up with your health insurance to do this online. I do this so I can examine these constantly.
BCBS sells thousanRAB of different insurance plans so there's no way to describe an "average" plan but I can give you an example.
My plan (UnitedHealthCare)
$300 annual deductible. I pay all costs (besides office co-pays) until I reach the $300.
$1500 annual out of pocket maximum
80/20 plan
So for each cost the insurance pays 80% of the cost, I pay 20%
This continues until I reach the $1500.
I had spine surgery in February and thus far have met $1000 of my out of pocket maximum. I'll likely reach it soon thus I am seeking to have any other care I need this year. Essentially I paid $300 deductible and have to pay $1500 out of pocket. Then every treatment after I pay only my office co-pays (I pay $20 for Primary Care physician and $40 for Specialist. However, with surgery he charges me for surgery and the first 3-6 follow ups don't require a $40 fee. So after I pay $1500 this year I pay no more if I have further surgery, am hospitalized, etc.
Every plan year you start over with the deductible, out of pocket max, etc.
Many policy years begin 1/1. Some education policies (for teachers, etc) begin 8/1 or 9/1 of each year. I have a friend here who has a husband that works for the city of Phoenix and their plan begins every year at 10/01.
If you get the exact plan I can walk you through what each thing means.
Oh, almost forgot: Personally I prefer Orthopedic Spine Surgeons but both OSS and NS are capable of doing the surgery on all parts of the spine. My OSS was going to do a ALIF and then his new partner did a Posteriolateral version (relatively new to the industry from what I understand. I had an incision down my back (around 6") and one on my side, above my hip, around 4". The side incision was used to access my spine from the front and to remove the disc between L3-L4 and place a spacer and bone in it's place.