Insurance questions

I am trying to work my way to get a Natale ablation. I have questions about insurance and cant get many answers from Natales office without having an actual policy. They did explain what types of insurance they accept but I'm unsure of actual out of pocket costs. the insurance company I'm looking into is Florida Blue. I'm not in Texas so the cost would be out of network/out of state. The deductible is roughly 15k.
I know for Natale they need to do some tests before in Texas. How much would this typically cost out of network? Also, How do you get referred from the state you reside in? Does it have to be from a local cardiologist ?
Out of staters: How much did a Natale ablation cost you out of pocket and can you explain the costs and the process of setting it all up?
I have to get this done asap. I'm heading towards permanent afib. Just got done with a 7 day straight bout of severe afib.
Thanks in advance.

You'll find the answers can be as variable as the insurance policy. I live out of state and have a BC/BS policy, and Natale and St. David's Austin/TCAI are still in-network. My out of pocket maximum is $4500, so that's the most I pay in a year. After that, there are no charges. So don't assume your policy doesn't have TCAI/St David's in-network just because you are out of state, and read the deductibles/co-pays/yearly out of pocket maximums.

Once you have a policy that is covered, make sure it is currently in force covering Natale and the hospital, then get your appointments made and communicate with your insurance along the way to prevent any misunderstandings etc. on your part. You'll likely max out your OOP maximum for the year (Natale or any ablationist), so maybe look for coverage with the lowest OOP yearly maximum that is in-network and the lowest monthly cost. See what the waiting period, if any, is for coverage and check on pre-existing clauses etc. My insurance paid a total of 40-50K, including the ablation, consult, CT scan and follow-up TEE in Austin because my LAA was isolated. Travel costs were on me, but I did get some of those back as tax deductions.

To add to AB's reply, if you're going to go this route you should definitely buy a policy that considers TCAI in-network. That's not hard to do since TCAI accepts most major insurers. Blue Cross, Aetna, Cigna, etc. are all good choices. The state you live in isn't really relevant here. The most important factor is simply choosing an insurer that considers TCAI in-network.

I think you can do better than a $15K deductible. And a deductible isn't the limit of what it will cost you. The limit is the policy's out-of-pocket maximum. You need to look at that number, not the deductible, because that's probably what you're going to pay. With that in mind, if you can't do better than a $15K deductible, then you should consider foregoing insurance. My understanding is that TCAI will do ablations for patients without insurance for a flat fee. Obviously, I don't speak for them, but I've been told that fee is on the order of $20K.

Also, you don't need to be referred by anyone. I wasn't. I simply called them and scheduled the procedure. My local EP did provide them with records, but that was after I was already scheduled. They knew nothing about my local EP when they accepted me as a patient.

Does Natale do Medicare patients? Just wondering.

Quote
Brian_og
Does Natale do Medicare patients? Just wondering.

Yes.

Quote
Carey

Does Natale do Medicare patients? Just wondering.

Yes.

Thanks!

Thanks for the replies. They certainly helped in understanding better about how insurance works. Unfortunately my state, Florida, is not a multi-state insurance provider. About half the country is but not Florida. This means that you can't use Florida insurance elsewhere unless its for emergency room services.
I guess I'll have to go back to my old surgeon who uses that harbor freight stick welding kit for ablation #3. Ehhh, life is full of compromises.
Seriously tho, I'll be talking to Natales office monday and see what other options may exist.

It just seems to get more convoluted. Natales office is saying that they have done many ablations to patients from Florida so they must except Fl insurance. They suggest talking to a insurance provider that deals with multiple insurance companies rather than just BC/BS. (I'll be doing this soon) They typically dont do cash only ablations. That is mostly only in the realm for international patients and its still in the 30 to 40k range.
Is there any member here from Florida that has used insurance to get a Natale ablation? Is there anyone that has paid cash?
So far, every door seems closed.

Florida Blue?

Quote
Billyjeans
Unfortunately my state, Florida, is not a multi-state insurance provider. About half the country is but not Florida. This means that you can't use Florida insurance elsewhere unless its for emergency room services.

That doesn't sound right. A quick web search shows all kinds of insurance plans available in FL that provide out of state coverage. I think the issue is more likely that you're in an HMO, and HMOs almost never cover non-emergency treatment anywhere but with facilities and doctors who are members of the HMO.

Quote
Carey

Unfortunately my state, Florida, is not a multi-state insurance provider. About half the country is but not Florida. This means that you can't use Florida insurance elsewhere unless its for emergency room services.

That doesn't sound right. A quick web search shows all kinds of insurance plans available in FL that provide out of state coverage. I think the issue is more likely that you're in an HMO, and HMOs almost never cover non-emergency treatment anywhere but with facilities and doctors who are members of the HMO.

You are correct. I need to get a florida blue PPO.



Edited 1 time(s). Last edit at 08/07/2018 12:24AM by Billyjeans.

HMOs are the pits. Pay extra for the PPO if that’s what it takes. There may be ways around the open enrollment, called “qualifying events”, but I must admit I don’t really know much about the individual insurance market.