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UCI medical center vs private practice costs
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UCI medical center vs private practice costs

Hi,

I'm seeing a hepatologist at UCI Medical Center and I have Blue Cross EPO.

I went for a consultation, blood test, & liver biopsy and the cost was about $11,000.00 total, before insurance coverage...So far about $600.00 out of pocket, but I'm scheduled for an ultrasound & EGD in the near future, then back to the doctor at the end of this month...Also, in the process of having my triple therapy (w/ telaprevir) authorized.

My question is, does this seem super expensive so far OR is this what these procedures are costing these days?

thanks!
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446474_tn?1404424777
"My question is, does this seem super expensive so far OR is this what these procedures are costing these days? "
It all depends on the coverage you have.

What is your deductible? Is UC Irvine Medical Center "out of network"? I have Anthem Blue Cross of Cali. I pay nothing most of the time as the hospital is "in network". Call and they will provide you with the details of your coverage so you know about how much you can expect to be charged.

Anthem Blue Cross of California
Exclusive Provider Organization (EPO) -  A healthcare benefit arrangement that is similar to a preferred provider organization in administration, structure, and operation, but which does not cover out-of-network care.

Customer Service Number: 1-877-687-0549,
TDD: 1-888-757-6034 (English and Spanish)
Monday - Friday from 7 a.m. to 7 p.m.

WHO CAN JOIN THE ANTHEM BLUE CROSS EPO PLAN
The Anthem Blue Cross EPO Plan is available to AIM-eligible pregnant women in the counties of: Alpine; Amador; Butte; Calaveras; Colusa; Del Norte; El Dorado; Glenn; Humboldt; Imperial; Inyo; Kings; Lake; Lassen; Madera; Marin; Mariposa; Mendocino; Merced; Modoc; Mono; Napa; Nevada; Orange; Placer; Plumas; San Benito; San Diego; San Luis Obispo; Santa Cruz; Shasta; Sierra; Siskiyou; Sonoma; Sutter; Tehama; Trinity; Tulare; Tuolumne; Ventura and Yuba.

In some rural areas, there are only a limited number of EPO Plan providers. If you live in a rural area, please contact Anthem Blue Cross regarding the availability of providers.

PLAN HIGHLIGHTS
As a member of the Anthem Blue Cross EPO Plan for AIM, you have your choice of Anthem Blue Cross EPO providers within your area. This includes physicians, hospitals and other health care professionals. The Anthem Blue Cross EPO Plan for AIM includes the following benefits:
You can go to any doctor in our Anthem Blue Cross EPO Plan network.
The Anthem Blue Cross EPO Plan network has a large selection of doctors to choose from near you.
Our Prenatal Program, a voluntary wellness program, is designed to reduce risks to babies by educating expectant mothers and offers you free gifts for participation.
MedCall® is a toll-free 24 free nurse help line staffed by registered nurses. Services include health education, health counseling and access to recorded information on more than 300 health topics including smoking and pregnancy.
We have a large selection of participating pharmacies from which you can choose. For your convenience, a mail order prescription drug program is also included.

PLAN PROVIDERS
The Anthem Blue Cross EPO Plan for AIM offers an extensive, statewide network of physicians, hospitals and other health care professionals from which you can select for your care.

You must use a provider participating in the Anthem Blue Cross EPO Plan network or you will not be eligible for benefits, except in an emergency.

Once your AIM Program application has been approved, a Anthem Blue Cross Provider Directory will be sent to you so that you can choose providers near your home or work.

HOW THE PLAN WORKS
How to Enroll

Simply write “Anthem Blue Cross EPO Plan” on the “Choice of Health Plan” line on the AIM application. No choice of Medical Group/Provider or Provider Code is required.

Once Accepted

First, select an EPO Plan participating physician from your Anthem Blue Cross Provider Directory. You must choose a participating physician from this Directory.

Second, call and make an appointment with your provider as soon as you receive your Anthem Blue Cross I.D. card. Remember, when you are pregnant it is important to begin your health care right away!

Third, call us so we can verify if the hospital you wish to deliver your baby is contracted.

If you need to consult a physician, your provider is available by phone 24-hours a day. Also, it is very important to remember that no benefits are available for services performed by a provider not participating in the Anthem Blue Cross EPO Plan network, unless authorized and approved by Anthem Blue Cross, or in an emergency.

For more information about the Anthem Blue Cross EPO Plan for AIM, please call 1-800-289-6574. We will be happy to answer any questions you may have regarding the Anthem Blue Cross EPO Plan for AIM.

The information presented on this page is only a summary. For exact terms and conditions you should refer to the Evidence of Coverage booklet for the Anthem Blue Cross EPO Plan for AIM.

HOW OUR PLAN WORKS
You get the care you need: You can go to any doctor in our large network of pediatricians, family and general practice doctors – anywhere in the state. You can take your child directly to any specialist in the network, when needed.

You get the prescriptions you need: You can use any of our many approved drug stores: Rite Aid, Walgreens, Longs, CVS and more, including many local, independent drug stores. Prescriptions are $5 to $15.

You get the answers you need: Our customer service representatives are available to help members Monday through Friday, 7 a.m. to 7 p.m.. For after-hours care, you can call your child's doctor or our nurse health information line.

Hope this helps.
Hector
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Avatar_m_tn
the most I have heard of for a Hepatologist visit was $600, all blood tests with most sensitive PCR $700 and liver biopsy $2000. So to answer your question yes this seems high. The only thing that could make it that much higher would be if there was a special biopsy done, i.e. wedge core or transjugular. But even with those type of biopsies 11k seems way high. Sometimes the doctor bills the insurance more but will only get the contracted price.
Good luck with your treatment
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Avatar_m_tn
The doctor and facility are in my network.

Regular biopsy was done.

will call blue cross on monday

thanks for the quick replies!
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Avatar_m_tn
oh, i have a $350 deductible.
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446474_tn?1404424777
Good luck!
Let us know what you find out.


Cheers!
Hector
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Avatar_m_tn
thanks, i will for sure!
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Avatar_m_tn
update

I called that Blue Cross number, but I work for a state agency and that number is only for federal issues, (that's what they told me)...

Since I have a $350 deductible, to date $600 out of pocket that isn't to bad.

Just got the approval for telepravir (30 per mo), pegasus (30 per mo), & ribavirin (10 per mo)...to say the least, I'm pretty happy with those prices.

I'm going to stay with the Blue Cross PPO, because I can go to any doctor, in any state, in the network without a referral.

I go back to the doctor on 8-30-11, prior I get another blood test, ultrasound...Unless something out of the ordinary pops up, I'm pretty sure he will start me on the triple therapy soon...

thanks!
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