Dr. Su - Aetna Insurance

[mmooney42]

Hi Everyone,
I'd like to hear what other people have experienced with Dr. Su as far as insurance coverage.  He does not participate with Aetna.  I've been told that Dr. Su's fee is around $10K - $11K.  Assuming Aetna will only pick up a very small piece of that, how does Dr. Su and his office work out the balance?  Will they negotiate it down?  Or is the patient on the hook for the full remainder of the balance?  Do they offer payment plans.

Feedback and insight is appreciated.

Thanks,
Matt

[chuckm]

Matt, I had my left hip done at Hospital for Special Surgery just over a year ago when I was 46 years old. There are a few surgeons there who do resurfacing. I used Dr. Boettner. He was "out of network" for my plan. But, my plan did have an out of network clause where they would pay 70% of expenses. It was some convoluted formula and I had to pay up front until I reached a $5,000.00 deductible.
Just so you know the entire cost at that hospital for this will ultimately be around $60,000.00.
The surgeon's fee is about what you said. I think mine was about $14,000.00. But then there is the hospital fee, anesthesiology fee, pathology, X-ray, blah blah blah. Suddenly it's another huge sum.
In the end my plan paid about $45,000.00 and I picked up the rest which was about $15,000.00. The surgeon will work with you to help.
It is worth it to be at that hospital. It was exceptional.

Chuckm

[oldsoccerplayer]

Matt,
you might want to check which HR surgeons do accept Aetna (a quick Google search shows that Dr. Raterman does). It's likely to cost less to travel to someone who does than to pay the out of network costs. You also need to check if the hospital they use also takes Aetna. Just a thought.

[mmooney42]

Thanks for the feedback.

I do know that HSS and anesthesia both take Aetna, so that part should be OK.  It's just the Dr. Su part that I am not clear on.  I didn't know if he was ever known to agree to a lower amount when someone is paying out of pocket??

Thanks,
Matt