Cost of insurance covered breast reduction
The definition of out of network means that the provider (surgeon, hospital, etc.) has not agreed to an allowable fee schedule set by the insurance company. Since the provider does not have a contract with the insurance company, they are not legally bound to accept what the insurance company allows, and the patient is legally responsible for whatever the provider charges. When undergoing a breast reduction, you will receive bills from the surgeon, hospital (or other operating room facility), anesthesiologist and pathologist (who will examine the breast tissue removed). Each of these providers may be in or out of network with your insurance company.
Using in network providers will generally result in a significant cost savings for the patient. With a maximum out of pocket of $2,000 (as stated in your question), your total responsibility would be limited to $2,000 (you should expect to pay the $2,000).
Hope this is helpful.
Price range for self pay breast reductions
$25,000 is an unreasonable cost estimate for a breast reduction surgery. A cash price in a surgery center or office OR for this would normally be about 1/4 to 1/3 that price ($6000-8000 total) in most markets. If I had to guess, that $25K number would be the hospital "sticker price" on the facility charge that would show up on your bill, but almost certainly not be paid at that rate by your insurance.
With your BCBS plan, it is not difficult to get your approval transferred to another practice that would be in network (patients do that for patients fairly frequently)
Is a breast reduction worth the money?
Thanks for your question. Although there is variation amongst difference insurances, hospitals, and geographic locations, the numbers you references above seem spot on for the Houston market. Note, these are INSURANCE prices, while the CASH price for the exact same service would be less than 10k, with the surgeon making about the same.
Although its complicated, you've highlighted growing issues with insurance reimbursement and why many private based plastic surgeons no longer take insurance in-network, for breast reductions, in particular. There are additional perks with paying cash as well- one main reason is that you and the surgeon can better negotiate how much volume to remove rather than be dictated by what is required in order to make it covered, which is often more than the patient or surgeon wants to remove to make your new breast size proportionate to your body.
Additional benefits of paying the cash price in my office include liposuction to the armpit and bra line if needed, provided garments, special glue tape to reduce tension on the incision line to promote healing and improve scar tissue, injection of long acting pain medication that slowly releases over 3 days to improved pain control, as well as included scar kit for post-operative scar management.
In conclusion, if you have found a surgeon that you like, in or out of network, it is definitely worth the cost. My breast reduction patients are amongst my happiest patients and the surgery can truly be life changing.
Best of luck on your journey.
Considering Breast Reduction in Melbourne, Florida
When considering breast
reduction surgery or any type of cosmetic plastic surgery, it is certainly the
case that quoted fees and costs can vary widely depending on the market, the
surgeon’s experience, the level of care, the surgeon’s level of training in his
area, particularly specialty training, and various other factors.
Therefore, it would be unrealistic to judge a particular fee quote as to
whether it is “worth it” for any particular patient. I have always found
that if you have found a surgeon that you like and you are confident in the
care and treatment that you will receive then cost must become a somewhat
secondary factor. My breast reduction patients are some of the most
satisfied, happy, and grateful patients due to the quality of results and also
the relief of the weight off the neck and shoulders. I hope this
information is helpful to you. Best of luck!
I would recommend calling your insurance and confirming which doctors are in your network. As for the cost of the surgery being $25,000,every patient’s case is different and depends on your insurance.
Why don't you choose a plastic surgeon that takes BCBS and then you don't have to worry about it. A breast reduction, if done cosmetically and totally out of pocket, shouldn't cost near $25,000. If there is a plastic surgeon that demands and gets that kind of money for a breast reduction, then the rest of us are doing something really wrong. That $25,000 may be what the hospital charges the insurance company, but they only paid a fraction of that. Best bet- find another surgeon- you are in Texas- there are plenty of really good ones there. Hope that helps.