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Topic: 20% copay BEFORE surgery?

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Oct 3, 2012 11:56AM

ConnieGreene wrote:

My breast specialist called and told me my copay for surgery is $650 and must be paid for by the 16th for surgery to happen on the 23rd...

YIKES!!!

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Posts 1 - 15 (15 total)

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Oct 7, 2012 01:32PM , edited Oct 7, 2012 01:33PM by tninalabama

My copay is less than that, but I have to pay it before the surgery. So, yes, it is normal operating proceedure for hospitals. They seem to think everyone has a stash to pay lots of money for these things. 

11/07 triple neg metaplastic, 12/07 lump, 01/08 bilat mast., EC x4,Taxotere x4, recurr 11/09, Xeloda x 6, Axill. dis. 07/10, rads,09/10, Pet scan 02/11, 3 nodes ,hilar,axillary, mediastinal, CTscan 05/11, NED 05/11, PET 08/11, still on Abraxane Dx 11/2007, , 2cm, Stage IIB, Grade 3, 1/6 nodes, mets, ER-/PR-, HER2-
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Oct 7, 2012 02:28PM proudtospin wrote:

yeah, I had foot surgery last summer, he asked for my full co pay of $1000 before surgery was set.  And when I did radiation 4 years ago, they wanted my $35 copay at each session.  Till the max out of pocket was met.  then they actuall runding my overpayment.

screwy as I just got a check from the hospital where I did my lumpies ...4 years ago.  Check for $5.80...over payment but also, 4 years ago

iris Dx 6/2008, DCIS, Stage 0, ER+
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Oct 7, 2012 10:33PM ConnieGreene wrote:

holy crap!

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 8, 2012 10:44AM peggy_j wrote:

FWIW I never had to pay these high co-pays upfront. My family doc used to ask for my $20 co-pay when I checked in but even that had changed. (we also changed insurance. Not sure if that's the reason) Just an FYI in case you want to consider switching docs. Personally I would prefer to choose a doc based on others reasons than their billing policy by if it's a hardship...

Dx 2/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Oct 8, 2012 10:53AM ConnieGreene wrote:

I will pay it...just had never heard of it before...she comes HIGHLY recommended by the medical world in MI (yep I checked)

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 8, 2012 03:15PM New-girl wrote:

I was shocked when my BS wanted it upfront even though she knew my max had already been met by all the testing.  Took me over 2 months and numerous phone calls before the office manager refunded it to me.  Oh yes she was highly recommened but her financial accounts person was the pits!

Dx 1/19/2012, IDC, 1cm, Stage I, Grade 2, 0/16 nodes, ER+/PR+, HER2- Dx 1/19/2012, ILC, Stage I, Grade 2, 0/16 nodes, ER+/PR+, HER2- Dx 1/19/2012, DCIS, <1cm, Stage I, 0/16 nodes, ER+/PR+, HER2- Surgery 2/13/2012 Mastectomy: Left, Right; Lymph node removal: Sentinel, Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Surgery 7/26/2012 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Surgery 12/14/2012 Reconstruction (left): DIEP flap, Nipple reconstruction; Reconstruction (right): DIEP flap, Nipple reconstruction
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Oct 8, 2012 04:33PM ConnieGreene wrote:

just wow

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 20, 2012 03:55PM Hadley wrote:

You know you can tell them you are unable to pay upfront and make a payment plan if that is easier for you. Some places allow that anyway.

Always go with your gut, you know your body better than anyone.
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Oct 20, 2012 05:51PM ConnieGreene wrote:

we paid it...just had never heard of it before!

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 20, 2012 10:52PM christina0001 wrote:

I have never experienced that before either.

Surgery 1/11/2012 Lumpectomy: Right Dx 1/16/2012, IDC, 2cm, Stage IIA, Grade 3, 0/7 nodes, ER+/PR+, HER2+ Surgery 2/10/2012 Lymph node removal: Sentinel, Right Targeted Therapy 2/13/2012 Herceptin (trastuzumab) Chemotherapy 2/13/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/10/2012 Mastectomy: Right Hormonal Therapy 8/24/2012 Radiation Therapy 10/1/2012 Breast Surgery 7/30/2013 Reconstruction (right): DIEP flap
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Oct 21, 2012 08:21AM ConnieGreene wrote:

well, at least it is out of the way, right?! One less bill to worry about coming in later! (gotta see the silver lining in everything!)

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 30, 2012 03:32PM dogsandjogs wrote:

Because my surgery was in the beginning of the year, I had not satisfied my $400 deductible. The hospital wanted it "up-front."  I complained to my insurance company. They said it was unusual to request it up-front, but it was not illegal.

Dx 11/1982, IDC, <1cm, Stage I, Grade 2, 0/17 nodes Surgery 11/17/1982 Mastectomy: Right; Lymph node removal: Right; Reconstruction (right): Nipple reconstruction Dx 11/15/2010, IDC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+ Surgery 2/11/2011 Lumpectomy: Left; Lymph node removal: Sentinel, Left
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Nov 4, 2012 06:15AM purple32 wrote:

WTH  kind of surgery?

My 20% for LX is $2400.00.

STILL havent paid it as they have advised me to apply for fin. aid.

Lymphedema on LEFT. NO radiation. 2 clean nodes. purple32. Hope is our light ... in the night. Dx 3/2012, IDC, <1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 5/1/2012 Lumpectomy: Left
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Nov 4, 2012 09:30AM ConnieGreene wrote:

that was the PS.....not sure what my BS copay is yet

Dx 9/5/2012, IDC, <1cm, Stage IIA, Grade 3, 2/20 nodes, ER+/PR+, HER2+ Surgery 10/23/2012 Mastectomy: Left, Right; Lymph node removal: Underarm/Axillary, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 12/3/2012 Herceptin (trastuzumab) Chemotherapy 12/3/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Hormonal Therapy 5/1/2013 Arimidex (anastrozole) Surgery 5/15/2013 Reconstruction (left); Reconstruction (right) Surgery 10/16/2013 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Nov 4, 2012 01:09PM purple32 wrote:

Oh, I see. MIne was just LX.

Lymphedema on LEFT. NO radiation. 2 clean nodes. purple32. Hope is our light ... in the night. Dx 3/2012, IDC, <1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 5/1/2012 Lumpectomy: Left