Out-of-Pocket Estimate
An estimate of the amount that you may have to pay on your own for health care or prescription drug costs.
The estimate is made before your health plan has processed a claim for that service.
If you are going into the hospital or surgical center you can expect a courtesy call the day before to inform you of their estimate of what you will have to pay.
Don't expect the person on the phone has actually asked your insurance company for a cost estimate. They are just going by a cost range and you will first be asked to hand over the high end.
Read your benefits summary and prepare for their call.
♦ If you pay too much upfront, you will suffer months of frustration getting a refund. Avoid the pain.
If you are on Medicare, you can get an estimate of Medicare's approved amounts by searching the procedure code.
Expect to be asked, "How do you want to pay?"
♦ Suggestion: Refuse to pay until you have seen the final bill and can compared it to what your insurance company says you owe.
The final cost can vary quite a lot depending upon the coding used to submit the claim. Waiting to see the final bill is the safest.
