@vcp02 I’ve consulted with Dr. Osborne twice but concluded I could not come up with money after going in circles with BCBS Illinois and getting nowhere. They refused to pre-auth and refused to pay in network benefits. They just paid about $25k for my right intraoral excision w/Dr. Patel in Portland in December but were only going to cover about $7k for Osborne. I’m an insurance adjuster so I was fully armed but couldn’t get anywhere. BCBS Illinois is staffed with particularly incompetent people. On my last call the person hung up on me when they couldn’t answer my question and I politely asked for a supervisor.
I’m now waiting to hear back from Dr. Hackman’s office. My preference would be Dr. Osborne because I’m in Oregon. If you know and are willing to share, I’d like to know what you were left with for your share of the cost. I’d like to avoid the frustration and phone calls with BCBS if I still can’t afford Osborne. My voice is affected and my employer will not accommodate me so there is urgency and financial pressure as a single person. I’ve exhausted FMLA so I could lose my job at any time.
My left side will be a revision because the styloid grew back after surgery in 2011 so I need an external excision at the skull base. Dr. Patel does not want to do it. I have a short lower jaw which Osborne said was a contributing factor and it will make it harder to access. Your story validates my 100% confidence in Dr. Osborne.
@Kiki67 - You & @vcp02 should discuss the financial details of her surgery via a PM. You can click on her screen name in this message & that will take you to a page where you can start a private discussion w/ her.
I’m really sorry your medical insurance is being so difficult to deal with. That’s got to be immensely frustrating!
@Isaiah_40_31 Glad to take it to PM, thank you. It’s been particularly frustrating when finding treatment and dealing with insurance needs to be done by phone and I have limited ability to use the phone.
The level of incompetence is absolutely unreal. I don’t understand why the “little” people are working so hard to stop innocent people from adequate healthcare when the only ones to benefit are the billionaire CEOS. Entirely a broken system, I’m sorry for your exhausted efforts and understand your struggle.
I am willing to share and will take Wendy’s advice as suggested on a private message. However, I still don’t know… I do plan on updating that process but a side from the “approval” it will take another 39-90 days before they respond to the claim Osborne has submitted. I do know I will still be required to pay the difference of Osbornes cost but cannot truly estimate that. Best guess ~ 10k.
I know the numbers for theses procedures are absolutely extreme but I’m curious if something like “care credit” can help someone in this situation. Its a “lower” interest credit card for soley medical expenses.
Dr Osborne told me he had a pt going to see him for her 3rd sx. Both surgeons prior had failed to remove it at the base of the skull which he stated was crucial to prevent regrowth. I will keep you updated the second I get anything from them.
“” its called PPO waiver request"… other places call it " out of network exemption"
A Blue Cross Blue Shield (BCBS) out-of-network waiver allows members to receive care from providers not contracted with their health insurance network, potentially at a lower out-of-pocket cost than if they went out-of-network without a waiver. These waivers are typically granted when in-network options are unavailable or inadequate for a member’s specific needs.
Waivers may be granted when:
There are no in-network providers available in the member’s area.
The member needs specialized care not available within the network.
The member is unable to safely transfer to an in-network provider.
The member has unique needs, such as language barriers or specific medical requirements.
We have a program called WITT that’s mentioned on our home page that’s designed for people who can’t afford to pay their bill completely or who need help around the house, someone to pick up groceries, walk the dog, provide a ride to a doctor’s appt., etc. The program allows an individual to create a list of help (including financial) needed & then to submit that list to friends, relatives, coworkers, etc. @Kiki67 & @Trisha, if your insurance doesn’t come through, WITT might be helpful for you to at least look into.
My regence BCBS Utah case manager says my condition is deemed as exploratory and even if the surgeon was in network they wouldn’t cover it. I sent in a PPO waiver, Dr hepworths note and pics of my scans before she told me this. I guess i’m on my own. Just wanted to keep everyone updated.
You are not alone. You may need to get stern, how can it be deemed exploratory when there are “specialist” treating this and when its been covered for other members. Most of the time its calling and speaking to the right person. I know your struggle, thank you for updating us and please keep us posted.
I agree w/ @vcp02! Completely ridiculous & out of line that your insurance would call ES surgery exploratory. You need to speak to a patient advocate who works for BCBS UT & clear that right up!! Someone on our forum even posted there’s a procedure code for ES now though I looked for the post a while ago & couldn’t find it. Mine were billed as craniectomies so you might try going with that.
I didn’t know there was a patient advocate. I will call and ask and see what happens. They made me so discouraged, ugh…I’m so frustrated and upset. I don’t know how cutting a bone out that is squishing your jugular is exploratory. I’m getting the surgery, I pushed way to hard to get where I am, and it will help me feel better so I can live life again🙏
Just wanted to send an update, BCBS of Utah completely denied my surgery. I ended up paying cash, Hepworth was 5,250 and the hospital will be sending a cash price bill for 20,000 then I can set that up on a payment plan. Ugh… makes me absolutely sick that it was denied but oh well, on the road to recover now thanks to you all helping guid me in the right direction. I will forever be grateful to this Forum. Without you, I’d still be in misery not knowing what the hell was wrong with me. I had a right side styloidectomy and jugular decompression yesterday morning. It’s too soon to tell but my arms aren’t as numb as they were so that’s great.
@Trisha, I’m so glad your first surgery is done & hope you don’t need a second one. It bodes well that you already have a little symptoms relief, but please remember that healing from ES surgery isn’t linear so symptoms can come & go as you heal. Listening to your body & resting when it asks (even a month out from surgery) & taking an easy day after longer more busy days will help you recovery faster.
I’m very sorry to hear what happened w/ your insurance though I have to say the cost for Dr. Hepworth & the hospital seem very reasonable compared to what other doctors/hospitals charge. I hope they’ve offered you a discount because you’re paying cash.
We’ve had several members take more invasive action against their insurance companies when their ES surgeries were denied. If you want to be more aggressive in your appeal against your company, consider what @lilwider & @Johnny99 said in their posts included in this thread, though reading the whole discussion would be good, too:
I had a right side styloidectomy and jugular decompression yesterday morning. It’s too soon to tell but my arms aren’t as numb as they were so that’s great.