Paying out of pocket for oral surgery
I was referred out by my orthodontist to have corrective jaw surgery [overbite correction]. After I get my jaw surgery I will have to continue treatment in braces until my teeth are perfectly aligned. The only Oral and Maxillofacial Surgeon in my area that works with my orthodontist is only covered under Cigna. I have Blue Cross. They will not allow an out of network exception nor will my GAP insurance cover the costs. I have to pay the full amount out of pocket, and my surgery is medically necessary because I have sleep apnea and have to wear a CPAP device each night. I was told by the OMS that had I had Cigna through my employer my insurance would be billed at a total cost of $85,000 including the surgeons fee, hospital, anasthesia, medical imaging and my insurance would agree to pay out 20%, meaning the insurance would pay just $17,000 for my surgery, and my deductible would be $2,000. Since I'm not covered under there insurance, I have to pay out of pocket for this whole cost. Why can't I negotiate a lower cost for my surgery since a majority of the patients who see this OMS are covered under insurance and they only get a 20% cut for the total surgery? I realize that insurance companies have a large customer base and they negotiate contracts with hospitals and surgeons and they can afford a discounted price for surgery patients, but it seems like people who pay out of pocket are taken advantage of? Has anyone negotiated a lower cost for cash-pay patients?
submitted by /u/Jensthename2
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