How much will I have to pay? Need help interpreting surgical payment sheet

I realize nobody on here truly knows, but I'm trying to decipher the treatment fee given by the oral surgeons office. I can't contact them until next week, so I just wanted to get some info in the meantime.

I have Priority Health insurance. I have a $500 Individual deductible and $8,100 individual out of pocket max.

There are three procedures:

Lefort 1: 8k

Mandibular Sagittal Osteotomy: 5.7k

Genioplasty: 2k

Total: 15.7k

________

But it also says my ESTIMATED SURGICAL FEE AND PAYMENT: 3.8k (does not include hospitalization or anesthesia). Shouldn't this be much higher than 3.8k because my out of pocket max is 8.1k?

________

My insurance covers the Lefort 1 and Mandibular Osteotomy 50%, but I have to pay for the genio since it's cosmetic. I don't understand the math here.

If I only have to pay 3.8k that's fantastic, obviously much lower than 15.7k. So is the estimated surgical fee what I'll have to pay (besides hospitalization and anesthesia)? The 15.7k figure is kinda scaring me.

My insurance only covers 50% of the Lefort 1 and Mandibular Osteotomy after meeting my 500 dollar deductible. But (8 + 5.7)/2 = 6.85, and then 2k for genio = 8.85… so why is my estimate 3.8k and not 8.85k?

I don't really understand insurance and this is confusing me. I'll be very happy if my price is around 3.8k (probably a couple grand more with anesthesia and hospitalization?), but I just need some help interpreting this in the meantime before I can contact my oral surgeons office again.

submitted by /u/waitingforstormgate
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See also  Letter of Medical Necessity