The Natural Bite

After five phone calls to my insurance company, and at least that many conversations with the hospital, anesthesiologist, and surgeon’s office, I finally have a vague idea how much this is all going to cost me.

Yep, that’s right, it’s only vague. One thing I’ve learned is that many patients won’t know the exact amount until after they’ve undergone their surgery, and thus incurred the associated costs. Bummer!

I’ve been incredibly lucky with the insurance people I’ve worked with, even considering the frustrating moments of uncertainty. I’ve had high-coverage insurance from a provider, and I’ve also had their blessing - a key factor in getting that coverage.

Here are the basics:

Surgeon’s fees
My Cigna Open Access Plus coverage, a PPO plan, allows for 70% coverage of usual and customary fees for the surgeon’s portion. This would be 90% if my surgeon were in-network, but I decided that, since this is my face after all, it would be worth it to go with a higher-cost, world famous surgeon, even though he is out-of-network. The trick here is the usual and customary fees - Cigna thinks this surgery should cost about $15K. My surgeon actually charges $19K. For me, that means I pay the difference ($4K) PLUS the 30% of the usual and customary fees that’s not covered (another $5K). Total out of pocket for surgeon portion = $9K.

Hospital and anesthesiologist
My hospital and anesthesiologist fees would normally put me back $45K (!) and $1,500, respectively. However, Cigna comes through on this one and caps my out-of-pocket at $2K for my hospital and anesthesiologist combined. Insurance coverage of $44K ain’t bad!

In sum, I’ll end up paying around $11K for a surgery that will be billed at $65,500.

It pays to have good insurance, and a surgeon who knows how to request coverage approval.