Pre-Surgical Estimate Included deductible for no-deductible plan?

I haven’t had to navigate much in the way of health insurance for a very long time and I feel like I have no idea what I’m doing. If anyone has advice I’d be so appreciative.

I’m on my partner’s employer provided PPO. We have never been charged a deductible – just copay – including for a trip to the ER & expensive diagnostics such as MRIs. It’s IBX / Blue Cross Blue Shield, $0 deductible and $4k OOP max, no coinsurance.

But the surgeon’s office estimate (in network) included $3k against my deductible which they say was pulled from whatever 3rd party system they use to generate said estimate, which I have to pay up front. Surgery is in just over two weeks and they need payment by next week.

Which wouldn’t be so bad if BCBS didn’t consider hip arthroscopy to be “experimental”, so I have to pay $3k out of pocket.

The whole reason I’m trying to do this now is that I’m unemployed (time for recovery) and have good insurance. The insurance company told me my copay for surgery is $120. Which I know doesn’t mean much. Facepalm.

Can I safely assume and push on the idea that this deductible is a mistake?

I asked the surgeon’s billing dept to explain how there can be any fees that apply to OOP max if you have no coinsurance or deductible, and I’m waiting for a response.


submitted by /u/die_hubsche

See also  California's Mission To Prove The Affordable Care Act Is Alive and Well