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General Category => Functional Surgery Questions => Topic started by: sanddunes on April 02, 2013, 08:48:33 PM

Title: Oral Surgeon Wants $850 Cash Pay for full "Workup" Even Though I Have Insurance
Post by: sanddunes on April 02, 2013, 08:48:33 PM

I consulted an "in-network" oral surgeon a few days ago about double jaw surgery.  I do have insurance (Aetna) that paid for my initial consult + jaw x-rays.  However, in order for him to interpret the x-rays and give me any more info, he wants me to pay $850 out of pocket (not billed to insurance) to do the full work up.  

Is this standard practice or does it seem unreasonable?  I mean, shouldn't he at least try billing the insurance for the workup?  

FYI for my consult + xray he billed $529 to my insurance, and my insurance paid him $300.  I at least wanted to know if my airway is narrow or not and he said he reads the x-rays as part of the "workup" which I have to pay cash for.  Should I be looking for other surgeons or is this normal??

Title: Re: Oral Surgeon Wants $850 Cash Pay for full "Workup" Even Though I Have Insurance
Post by: trigeminalneuralgia on April 03, 2013, 09:08:00 AM

i have aetna,

i hate them

Title: Re: Oral Surgeon Wants $850 Cash Pay for full "Workup" Even Though I Have Insurance
Post by: sanddunes on April 03, 2013, 03:42:15 PM

What has been your experience with Aetna and getting them to pay for Orthognathic surgery? 

Title: Re: Oral Surgeon Wants $850 Cash Pay for full "Workup" Even Though I Have Insurance
Post by: Marisama on April 04, 2013, 05:20:13 AM

Aetna is the worst.

Title: Re: Oral Surgeon Wants $850 Cash Pay for full "Workup" Even Though I Have Insurance
Post by: trigeminalneuralgia on April 04, 2013, 08:56:23 AM

ive never tried to get them to cover surgery
but ive had diagnostic procedures and sometimes they go toward my in-network deductible (basically meaning i pay for them) and sometimes theyre paid for

they also denied my physical therapy after so many visits without ANY warning.  and with pt you cant get "pre-approval" because you have to go in once a week, so basically you go in and hope to god aetna pays for it, then six months later get a lovely bill.

Title: Re: Oral Surgeon Wants $850 Cash Pay for full "Workup" Even Though I Have Insurance
Post by: x on April 05, 2013, 04:50:17 PM

yeesh sounds like a nightmare

anyone else have Humana?