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  • How do I determine what Blue Cross/Blue Shield conciders customary and reasonable for vaginal delivery? My OB is out of network and charges 7k but when I called blue cross they told they had no way of knowing how much of that would be covered until after i submit the claim.

    18 replies [ Reply | Watch | Options ]
    04.17.08, 08:57 AM [ Flag ]

    • can't you just find an in-network ob?

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      04.17.08, 08:58 AM [ Flag | link to this post ]

    • get someone else on the phone

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      04.17.08, 08:59 AM [ Flag | link to this post ]

    • can someone at your OBs office tell you? My OB is out of network everywhere, but the office administrative person was very helpful iin giving us ballpark info about what our out-of-pocket costs were likely to be.

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      04.17.08, 09:00 AM [ Flag | link to this post ]

    • that's why i went in-network in the end, too many uncertainties

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      04.17.08, 09:00 AM [ Flag | link to this post ]

      • np: unfortunately, the better OBs in NYC are not renewing their contracts with the insurance companies. Why deal with the administrative nightmare if they have patients who are willing to pay out of pocket?

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        04.17.08, 09:05 AM [ Flag | link to this post ]

        • you have to be superrich to pay out of pocket, because the hospital costs may not be covered either - i.e. you could maybe have a bill of 25,000, or something nlike that

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          04.17.08, 09:07 AM [ Flag | link to this post ]

          • Not true. I am paying out of pocket and am far from super rich. My hospital is in network and my OB is out of network. At the end of the day, I will probably pay about $1700.

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            04.17.08, 09:09 AM [ Flag | link to this post ]

          • OP: Hos is covered, just not OB

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            04.17.08, 09:09 AM [ Flag | link to this post ]

          • most NYC hospitals are in network for the major insurance companies and once you meet the OON deductible, you'll be paying less than half of the total cost. once upon a time, most insurance worked this way

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            04.17.08, 09:09 AM [ Flag | link to this post ]

          • if you go to an in-network hospital, the hospital costs are covered.

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            04.17.08, 09:14 AM [ Flag | link to this post ]

        • I'd imagine collecting your fees is a battle either way

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          04.17.08, 09:10 AM [ Flag | link to this post ]

    • BCBS sucks - I just had the same thing - they eventually covered about 80% but it was a fight

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      04.17.08, 09:01 AM [ Flag | link to this post ]

    • Re: How do I determine what Blue Cross/Blue Shield conciders customary and reasonable for vaginal delivery? My OB is out of network and charges 7k but when I called blue cross they told they had no way of knowing how much of that would be covered until I had the same issue with Oxford. My out of network OB told me that patients generally end up spending under $2,000 out of pocket (assuming reimbursement at 80% of usually and customary). Make sure that your hospital is in network, though.

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      04.17.08, 09:03 AM [ Flag | link to this post ]

      • thx, hos is in network. PLan we have with BCBS covered 100% out of network costs but thats R&C, anything above that we are resposible for

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        04.17.08, 09:11 AM [ Flag | link to this post ]

    • When BCBS covers OON, it's usuall after a larger deductible and then you have 20-40% coinsurance. My guess would be, if you're lucky, they'll pay out $2K.

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      04.17.08, 09:08 AM [ Flag | link to this post ]
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