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Old 03-04-2016, 11:29 AM
Mark in Idaho Mark in Idaho is offline
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Join Date: Feb 2009
Location: Somewhere near here
Posts: 11,418
15 yr Member
Mark in Idaho Mark in Idaho is offline
Legendary
 
Join Date: Feb 2009
Location: Somewhere near here
Posts: 11,418
15 yr Member
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I suggest you call UPMC and talk to them about the common services and treatments they provide to someone with your range of symptoms. They should be able to give you the CPT (procedure) codes. Then, you can call the billing department and ask what the fees are for those codes.

Many never see the direct costs, just the part they need to pay. Plus, the costs they may see are the 'list prices' that can be twice what the real amount they accept as payment are.

I've been dealing with three surgeries in the past 4 months and making sense of a bill takes an accounting degree. EOBs (Explanation of Benefits) will show the gross (list price) amount, what the insurance paid and the amount owed by the insured. So, you need to add up the amount the insurance paid and the amount the insured owes to get the amount the provide will likely accept.

If your insurance is not good, you can check out the prices Medicare pays for the various CPT codes and expect to have to add 60% to that amount to get to an amount they will likely accept. There are health plans that do not use networks, that use this Medicare plus 50, 60 or 70% price structure to pay providers. Here is a link to the CMS fee schedule. Click ACCEPT and the next page has a CPT based fee lookup. Choose all modifiers. You can look up your locale and enter it, too. This can give you a starting point.
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Mark in Idaho

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