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$3000 for cataract surgery with BCBS Basic - Can I do better?
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flamingofed  
#1 Posted : Thursday, September 30, 2021 7:30:01 AM(UTC)
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I need cataract surgery on my left eye and was told my portion of BCBS Fed Basic would be $3000. I decided to wait until open season to see if there are any cheaper options. Would anyone here have any expertise as to what insurance may have a better deal for something like this?

Thanks!
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HoosierDaddy  
#2 Posted : Thursday, September 30, 2021 9:06:35 AM(UTC)

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I did a procedure cost estimate at fepblue.org for cataract removal. I live in a rural area but it listed 47 places within 100 miles where I could have the surgery and the estimated out of pocket cost at all 47 places was $300. Sounds like you were given some wrong info.

Edited by user Thursday, September 30, 2021 9:33:43 AM(UTC)  | Reason: Not specified

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flamingofed on 10/1/2021(UTC)
flamingofed  
#3 Posted : Thursday, September 30, 2021 9:10:32 AM(UTC)
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The $3000 amount was given to me by the eye clinic. They would not do the procedure unless I paid upfront. So from you're saying, I should go to the website and I can somehow cost compare? How do I do that?
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Navy Bubblehead  
#4 Posted : Thursday, September 30, 2021 9:10:56 AM(UTC)
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Originally Posted by: flamingofed Go to Quoted Post
I need cataract surgery on my left eye and was told my portion of BCBS Fed Basic would be $3000. I decided to wait until open season to see if there are any cheaper options. Would anyone here have any expertise as to what insurance may have a better deal for something like this?

Thanks!


Who told you that? If it was the clinic/surgeon office, have them call and verify your benefits. They told you what the computer was showing them. My wife recently did her pre-op work for some major spinal surgery. The lady told us our share was over $3200. We told her that wasnt right. She called BCBS and verified our benefits. Our share was $350.
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flamingofed on 10/1/2021(UTC)
HoosierDaddy  
#5 Posted : Thursday, September 30, 2021 9:54:49 AM(UTC)

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Originally Posted by: flamingofed Go to Quoted Post
The $3000 amount was given to me by the eye clinic. They would not do the procedure unless I paid upfront. So from you're saying, I should go to the website and I can somehow cost compare? How do I do that?
If you have a fepblue account login here:
https://www.fepblue.org/pilot/lo...tlet_partnerId%3Dsp_bcbs

Click on estimate my costs then type in cataract surgery.
You can't fix stupid, but you can vote it out. https://www.youtube.com/watch?v=DG29PVMtAWE
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flamingofed on 9/30/2021(UTC)
Bob Loblaw  
#6 Posted : Thursday, September 30, 2021 10:29:11 AM(UTC)
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Are you sure your Dr is in-network?
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flamingofed  
#7 Posted : Thursday, September 30, 2021 11:45:17 AM(UTC)
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My doctor is in network. I went to the link above and it said my out-of-pocket cost should be around $300. So what the heck is going on? I guess I need to call BCBS. I so appreciate all of you taking the time to post and offer suggestions! Thanks again.
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old fed  
#8 Posted : Thursday, September 30, 2021 1:04:56 PM(UTC)
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Originally Posted by: flamingofed Go to Quoted Post
I need cataract surgery on my left eye and was told my portion of BCBS Fed Basic would be $3000. I decided to wait until open season to see if there are any cheaper options. Would anyone here have any expertise as to what insurance may have a better deal for something like this?

Thanks!


nope, that doesn't sound right. I had mine done about three years ago (I haven't looked at the coverage for outpatient procedures lately) but at the time my share was $100/eye for surgery center and ~ $200 for the surgeon? something like that with basic

$3000 is way out of line. something is wrong there.
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flamingofed on 10/1/2021(UTC)
MovinUp  
#9 Posted : Friday, October 1, 2021 11:23:46 AM(UTC)
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Originally Posted by: flamingofed Go to Quoted Post
I need cataract surgery on my left eye and was told my portion of BCBS Fed Basic would be $3000. I decided to wait until open season to see if there are any cheaper options. Would anyone here have any expertise as to what insurance may have a better deal for something like this?

Thanks!


$3000 is not out of line if you are getting premium lens (toric, multi-focus, etc). So far as I know, no FEHB plan or medicare covers these. Also you need to check to see if surgery center is in-network (doctor may be but not surgery center). And check whether doctor is doing laser incision (not covered) or traditional scalpel (covered). Some doctors will include "future costs" of any corrective surgeries that may be desired if the cataract surgery is not optimal. These will not be covered either.
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flamingofed on 10/1/2021(UTC)
MovinUp  
#10 Posted : Friday, October 1, 2021 11:28:42 AM(UTC)
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Don't forget to allocate funds for this in Flex spending account if you can during Nov open season. I maxed mine out, but needed surgery on both eyes.
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flamingofed on 10/1/2021(UTC)
flamingofed  
#11 Posted : Friday, October 1, 2021 11:28:45 AM(UTC)
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No, I'm not getting anything fancy, just a normal cataract removal. I'm not sure about the laser versus scalpel. I called insurance today, but of course their recording asked me to leave my number and they would call me back, and they never did. That was this morning. Sigh.
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GWPDA  
#12 Posted : Saturday, October 2, 2021 6:39:22 AM(UTC)
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I remember my opthalmologist's office using that $3000 figure for laser cataract removal (both eyes) with astigmatic lens replacement. This was about a year ago. They assumed I was on Medicare, but in fact, I was still working and on GEHA standard. My out of pocket expense was around $300 or so. Maybe a bit more - but hey! everything's expensive in Honolulu. GEHA had no problem covering the laser procedure, the surgical center, the opthalmic surgeon and the astigmatic lens, all according to their very standard surgical protocols. Yes, everything was 'within network'.

Edited by user Saturday, October 2, 2021 6:43:15 AM(UTC)  | Reason: Not specified
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The HalfBreed  
#13 Posted : Sunday, October 3, 2021 1:41:08 PM(UTC)

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Many people switch to BCBS BASIC, cheaper than Standard, and they love the ~$800 annual rebate.

I've seen this over and over, and you get what you pay for in many instances, which is why I continue to keep BCBS Standard.
It's all good til it goes "Off the rails"...check and see if that's the issue. I suspect it is, and I guess you have Medicare A and B as well.
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old fed  
#14 Posted : Sunday, October 3, 2021 3:30:38 PM(UTC)
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Originally Posted by: The HalfBreed Go to Quoted Post
Many people switch to BCBS BASIC, cheaper than Standard, and they love the ~$800 annual rebate.

I've seen this over and over, and you get what you pay for in many instances, which is why I continue to keep BCBS Standard.
It's all good til it goes "Off the rails"...check and see if that's the issue. I suspect it is, and I guess you have Medicare A and B as well.


my coverage is basic, not standard. it was ~ $300/eye

I checked the new brochure for 2022, seems to still be the same for basic
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The HalfBreed  
#15 Posted : Sunday, October 3, 2021 3:53:58 PM(UTC)

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Originally Posted by: old fed Go to Quoted Post
Originally Posted by: The HalfBreed Go to Quoted Post
Many people switch to BCBS BASIC, cheaper than Standard, and they love the ~$800 annual rebate.

I've seen this over and over, and you get what you pay for in many instances, which is why I continue to keep BCBS Standard.
It's all good til it goes "Off the rails"...check and see if that's the issue. I suspect it is, and I guess you have Medicare A and B as well.


my coverage is basic, not standard. it was ~ $300/eye

I checked the new brochure for 2022, seems to still be the same for basic




I Saw your post...I was referring to the Original poster, who said it was $3,000.
Sorry if that confused you.

RETIRED CSRS 12/19/2012 @ age 57 w/39 years.
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old fed  
#16 Posted : Sunday, October 3, 2021 8:37:16 PM(UTC)
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Originally Posted by: The HalfBreed Go to Quoted Post
Originally Posted by: old fed Go to Quoted Post
Originally Posted by: The HalfBreed Go to Quoted Post
Many people switch to BCBS BASIC, cheaper than Standard, and they love the ~$800 annual rebate.

I've seen this over and over, and you get what you pay for in many instances, which is why I continue to keep BCBS Standard.
It's all good til it goes "Off the rails"...check and see if that's the issue. I suspect it is, and I guess you have Medicare A and B as well.


my coverage is basic, not standard. it was ~ $300/eye

I checked the new brochure for 2022, seems to still be the same for basic




I Saw your post...I was referring to the Original poster, who said it was $3,000.
Sorry if that confused you.

I'm not confused, I am providing an example that basic did not go off the rails as you say. I have basic, I checked the new brochure which includes basic coverage which is the same coverage as OP
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The HalfBreed  
#17 Posted : Monday, October 4, 2021 7:38:41 AM(UTC)

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Originally Posted by: old fed Go to Quoted Post

I'm not confused, I am providing an example that basic did not go off the rails as you say. I have basic, I checked the new brochure which includes basic coverage which is the same coverage as OP


Well, I'm part of a Federal Retiree group on Facebook, over 4,000 members, and I HAVE seen their dismay over the issue.

Without mentioning names, one guy had been happy for a very long time with that setup, but went into a hospital for work / operation and verified (he thought) all Dr's etc were participants....well, some tests were not, along with a Dr or two that weren't.

He was happy til he got the ~ $5,000 bill that neither Medicare A, B or BCBS BASIC would NOT cover. I'm not arguing your point of view.
I AM saying it does happen, and that's when the it went off the rails. He's still fighting it after 2-3 months now.

I personally don't like surprises like that, and my choice to stay on Standard is just that.

MY choice.

If you're happy with YOUR choice, then I'm happy for you.

The real issue here is the Original Poster. Not our own experiences.

Edited by user Monday, October 4, 2021 7:39:26 AM(UTC)  | Reason: Not specified

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old fed  
#18 Posted : Monday, October 4, 2021 11:28:15 AM(UTC)
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Originally Posted by: The HalfBreed Go to Quoted Post
Originally Posted by: old fed Go to Quoted Post

I'm not confused, I am providing an example that basic did not go off the rails as you say. I have basic, I checked the new brochure which includes basic coverage which is the same coverage as OP


Well, I'm part of a Federal Retiree group on Facebook, over 4,000 members, and I HAVE seen their dismay over the issue.

Without mentioning names, one guy had been happy for a very long time with that setup, but went into a hospital for work / operation and verified (he thought) all Dr's etc were participants....well, some tests were not, along with a Dr or two that weren't.

He was happy til he got the ~ $5,000 bill that neither Medicare A, B or BCBS BASIC would NOT cover. I'm not arguing your point of view.
I AM saying it does happen, and that's when the it went off the rails. He's still fighting it after 2-3 months now.

I personally don't like surprises like that, and my choice to stay on Standard is just that.

MY choice.

If you're happy with YOUR choice, then I'm happy for you.

The real issue here is the Original Poster. Not our own experiences.


that has nothing to do with this specific issue mainly because the info the OP got is most likely wrong and not due to having basic.
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The HalfBreed  
#19 Posted : Monday, October 4, 2021 11:36:50 AM(UTC)

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Originally Posted by: old fed Go to Quoted Post

that has nothing to do with this specific issue mainly because the info the OP got is most likely wrong and not due to having basic.


MOST likely. He's not sure, and told us what he got for an answer.
I won't dispute his findings...but, I'm sure you know more about his issue that he does.

He'll find the answer eventually.

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