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NS fees alone?

Hi everyone.

Does anyone have a basic ball park idea of what the NS's fee is, not including hospital stay, anesthesia etc-- only the NS fees? I have pretty good insurance and everything will be covered in network, except the NS alone will be out-of-network so I will have a higher deductible there. I just trying to get a basic idea of what I am going to have to pay in the end. The NS's staff told me not to worry about it and they would work with me about the payment, but I would still like to get a basic idea.
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620923 tn?1452915648
COMMUNITY LEADER

  FABULOUS bit of info !!! Thanks for posting this.
Helpful - 0
Avatar universal
I am in AL, but the surgery will be done in NC as there are no Chiari experts near me. The one NS I saw here, I think I might know more about CM than him... Two NL insisted that CM1 never causes any symptoms and referred me to a psychiatrist. Ironically the Psych said im not suffering from a psychological problem and said he believed CM was the cause of my symptoms...
Helpful - 0
1 Comments
Since you went out of state due to no specialist near you, I bet this would work for you like it did for me.  File a complaint HERE:

http://www.aldoi.gov/consumers/FileComplaint.aspx

So part of the Affordable Care Act legislation says that our health insurance must have a specialist in network within a reasonable distance to cover everything we need  ... even though CHIARI is not a recognized sub-specialty for neurosurgeons, and there is no official list of chiari specialists ... all I had to say was that I have chiari malformatian and there is no neurosurgeon in network that I am comfortable with, but here is a specialist that does "specialize" in chiari and it is not fair that I have to go OUT OF NETWORK for care, when there is no in network option.  I got the network adequacy exception in about a week from the Texas insurance commissioner.  

Call your insurance company and let them know what you're doing (filing in network adequacy complaint) and watch the magic happen. ;p

DO NOT! pay any out of network fees.  Getting reimbursed is a much bigger headache.
4760166 tn?1398357313
what state are you in?  if there is not a chiari specialist in network you can request a network exception due to an INADEQUATE network! even if other neurosurgeons are in network ... I got my surgeon in network that way with Cigna.
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Avatar universal
I am VERY fortunate that I did not have to pay anything for 3 major surgeries. I would've been in debt for life I feel. I did see the cost for my decompression surgery & it was just crazy big numbers! But, even if I had to pay, I would've! I know(even with the challenges before me, from the surgery) it was the right decision. Is your surgery date already scheduled? I'd ask for costs written in detail. A surgery I had years ago tried to bill me twice - I fought that, (it was anesthesia costs). And they dropped that once I asked for a detailed / itemized list-which was duplicate to what I'd already paid. So, get everything written, I'd say. Of course there's always the chance of unforeseen costs due to unforeseeable situations. But, you should be able to get a pretty clear $ down.
Helpful - 0
620923 tn?1452915648
COMMUNITY LEADER

  That is great you spoke with your INS ...most will allow an appeal if a bill also so do not forget you have that option too.
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Avatar universal
Thanks guys, my deductible for in-network is 3700usd, out of network 7200. I imagine I am going to end up paying around 10000, I am hoping my insurance will allow my NS to be considered in network or at least combined the deductibles. I have made a request (I was told about 50% chance of success).  
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620923 tn?1452915648
COMMUNITY LEADER

  TCI works out of a "normal" hospital too....they do not do surgery at their offices....so not sure how it will make a difference in that regard....the only difference I can see here is with the Dr them self....

I really do not recall costs just remember them being high.....I had to pay cash to see my NS for the first visit....after that everything else was covered by my INS....NL and Hospital etc....the only recall issue I do recall is with the anesthesiologist group that kept billing incorrectly somehow they did not have my information and kept reporting it to NY instead of PA....so they tried to collect from me directly after I corrected the info several times...I won that one as they dropped it and cleared me of owing them anything.....which was a big relief.....it was all operator errors inputting the info.....

Helpful - 0
4760166 tn?1398357313
Oh ... and I'm not sure where your $30k figure comes from ... granted both times I've spent more than one night in neuro ICU ... it is at least $80k total, when it's all said and done.  That $30k figure MIGHT be what your room and board cost is if you spend 1 night in NICU and two nights in the hospital.  The last surgery I had (11-18-15) the hospital was SO stingy and tried to bill everything separately, including the operating room.  My insurance kicked most of the bills back saying it should have all been included in my hospital fees .... and sometimes the separate doctor bills will be kicked back too.  As long as they're in network .... that's the lame part, even if the hospital is in network, you can have doctors and anesthesiologists out of network.  And you really won't know this until bills start coming in.  The big one is the anesthesiologist, though.  
Helpful - 0
4760166 tn?1398357313
I have had this surgery twice now-- first! Make sure the anesthesiologist is in network. They cost more than the surgeon and work like private contractors.   The BIG bill from the hospital also usually doesn't include lab work and any scans you might have after surgery.  It will also not include ANY doctor that even looks at your chart.  So ..:. My neurosurgeon was paid just under $1k by my insurance.  He BILLED my insurance over $10k. But he was in network so there was a big "discount" there. I would definitely ask your surgeons office what his cash patient fee is -- insurance companies pay using medicare's reimbursement schedule. That is where insurance companies get their "max fee" ... So if my surgeon wasn't in network. i would have gotten the full $10k Bill. Or maybe your neurosurgeons office is willing to bill you at that discounted rate that in network patients get ... Id get something in writing if that is the case.

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Avatar universal
Hi Selma! I know everyone is different, I was just hoping to get a basic idea. I have heard the average Chiari surgery costs around 30000usd. I assume a big chunk of that is hospital fees such as room, anesthesia, medicine etc. I was just wondering about what percentage the NS gets out of that for this surgical services.
My surgery will be done at a normal hospital, not at a specialist clinic such as the Chiari Institute, I have heard that makes a difference.
Helpful - 0
620923 tn?1452915648
COMMUNITY LEADER

  Each will be different and now more and more NS'S are working with INS...they did not when I had my surgery.....

ANd since mine was almost 7 yrs ago, I am sure costs have changed......you should be able to contact your Drs finance/billing office to get an idea...also speak with your INS carrier to see what they will cover.
Helpful - 0
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