dr Su and Anthem/BCBS

[demens13]

Anyone with anthem/bcbs can share the process of figuring out the cost for this?

I called the insurance comp and Su's office. So far I was told that his surgical fee is $28k

My insurance said they need CPT codes otherwise they can't tell me anything. One code they did look up was CPT code 27130 which i think is right and the max allowed is $1600. They pointed me to https://www.cms.gov/medicare/physician-fee-schedule/search to see for myself, indeed, $1600 is there listed in the "facility" section. But that can't be the surgeon fee right? It's not possible that he charges $28k and my insurance is willing to cover $1600.

My max out of pocket for out of network is ~$10k, which i can handle, but by the sound of it, thats not i'll end paying.

[Danlalane]

I have Primera BCBS and the max they are paying is $1,900 of the $28k. None of the max limits apply. The good news is they picked up all the HSS fees $110k+.