Originally Posted by Mark in Idaho

Two surgeries for me in October. A nasal rebuild (deviated septum and turbinoplasty) and a shoulder scope and repair. Both went fine except the shoulder is still a problem. Sorting out the nasal bill was easy but cost me $200 more than I was told it would. The shoulder surgery bill was a mess.

My wife had one surgery in January and is headed for a second surgery next week. Had to change health plans to get the specialists she needs. Prior health plan refused to refer her to an out of network specialist. Fortunately, she had an open enrollment period that ended Feb 29. We took advantage and got her better coverage.

So, I have become an expert at understanding how providers bill and how insurance companies pay. I also learned a lot about how insurance companies define medical necessity so they can avoid the specialists.