AmandaD.

Hello! Just a question about insurance & how they normally bill since I am completely new to this & just beginning! My insurance has a $1,400 deductible & then afterwards covers 80%. Would I have to pay the other 20% upfront or do I get billed for that after surgery? I know it seems crazy to ask but I was pregnant last year and my insurance company made me the estimated percentage that they did cover up front - making me come up with $6000 in 30 days or they stated they were dropping me from my OB. I think they called it global authorization or something weird. I just didn’t want to be blindsided getting a letter a few months in having to come up with a large lump sum in a short period. Thank you! Hope all is well on your journey's!

That is crazy. This is the first I am hearing of a “max lifetime benefit” for Bariatric - I’ll have to look into that. I still have time I have three options for insurance. BCBS is one of them but I’ve had them before and they were honestly a complete nightmare constantly messing up claims from a pregnancy, so I won’t go with them anymore haha. That also makes it seem like your surgery is crazy expensive lol which procedure are you getting done? My OOP max across the board is 3000 so I’m hoping that’s all I have to pay out of pocket. Hopefully you only end up paying $400! This whole process seems stressful, and long. Hoping to get my surgery summer on 2023! Good luck in your adventure!

Hello! Just curious how long you needed off from work? I work from home so I am sitting all day… but did you take vacation time? FMLA? Thank you!!

Hello everyone! Currently I am not under my employers insurance plan yet. They list three different companies/plans: Aetna Choice POS ii (open) Blue Cross Blue Shield PPO United Healthcare Choice plus I am trying to get more information in the months to come on specifics (pre op requirements, if I need to go to a "center of excellence", etc.) I spoke to my job's HR dept. and they only gave me their medical benefits PDF which includes a very vague breakdown of their own requirements (BMI over 40, nutritionist, psych, physical commitment) other than that they just state to add whatever requirements are listed on the specific insurance policy. I thought it would be as easy as just calling these three companies and asking them their requirements based off of specific plans and I keep getting the run around. Most state that they can assist until I have enrolled so they can see specifics, but my jobs HR states I should be able to call and ask ahead of time. Do I need to wait until I enroll? I was hoping to call each company so I can compare/contrast pros/cons (I would prefer only needing 3 months of dietician, etc. rather than 6, etc.) but it seems I have to just (sort of) blindly pick one and hope for the best? I guess I assumed that each plan has it's own specific requirements set it stone, and then possible other ones that my job may add in... just seems a lot more difficult to try to get everything organized before diving in. Thank you!!

My insurance is strict with who they allow, but I can’t get a list of approved in network surgeons until I pick a policy I guess - which is annoying I wish there was a way to get all of this information before hand so you can research.

I have looked at the breakdown of my jobs medical insurance policy and it says that it covers medically necessary Bariatric surgery 80%. So I know it’s covered (for the most part). I was just hoping to get the break down on what the individual insurance policies include for pre op requirements, etc. My jobs break down is very vague. All it says is that it covers it if the BMI is 40+ and I get nutritionist and psych eval… then it says “and also complete what the insurance provider states…” but I can’t get specifics I guess until I enroll?? Thank you!

Hey everyone! I am just starting out my process trying to get all my ducks in a row before January when my insurance kicks in and everything begins… is there any significant difference when choosing a hospital setting over a Bariatric specialist setting to get gastric bypass procedure? I would assume maybe billing might be easier going through a hospital but any other pros/cons? Thank you!

Thank you!!

Yeah, it would all be done at the specialists facilities. So all appts & procedures would be done there as well as he has his own dietician, etc. He has great recommendations/ratings but I’m back and forth which is best. Thank you!

Ok, I’m sorry for all these questions I’m just new to all of this… so theoretically I’ll get bills throughout my mandatory procedures (therapy, dietician, appts, etc) that will be my deductible that I would need to pay when due. Then I would tell my Bariatric specialists office that I will pay them after insurance processes the claim? Is the out of pocket maximum part of that small chunk bills that I’ll be getting throughout my appts, etc or is that after the surgery as well??

How do you get away with not pre paying? From my experience (just from being pregnant) they basically threatened me stating I had no choice lol are there ways to tell insurance you would like to be billed at the end after insurance and only pay deductible first? My deductible is $1,400. My whole process isn’t starting until Jan 1st because I’m switching to my job’s insurance during open enrollment this year. My out of pocket max is $3,000. So I would (more than likely) pay my out of pocket max AND my deductible ($4,400) before surgery and if they try to have me pay the 20% as well tell them I would like to wait? This is all confusing so I just want to get as much info as possible. Thank you!!

Sorry, never mind the last question, I didn’t see the first answer up top lol thank you!

Yeah, that makes sense for sure. Do you mind me asking how much your total due was?? My insurance pays 80% so I’m assuming my out of pocket with deductible will probably be around 5-7,000. I appreciate the info!!

@kcuster83: Did they charge you just your deductible up front before your surgery or did you have to pay the difference /percentage in procedures, etc that your insurance didn’t cover up front as well?

Thank you all so much for the responses!!!

Hello! Does anyone have this insurance and can divulge more info about criteria/out of pocket expenses during the process? Looking into getting GB but need more info before hand - thanks!

Hello everyone - greetings from sunny Florida! Just had my first convo with my GP about how to get started with this journey… she said to start with calling insurance companies. Do I just start calling random companies and see their criteria?? I’m completely in the dark about this process. After the insurance process what would be next? Any help/your own process stories would be appreciated! Thanks 😊

Thank you all for your suggestions! I actually found out my employers insurance (which I don’t currently have now) covers Bariatric surgery! So my plan is to enroll in Nov & start my journey in January! Anything I can do prior to get me ready? For the weight loss program is that something you wait for and your dietician gives you or can you pick one and do that ahead of time? Appreciate it!

Thank you so much for that information! Looks like my plan covers 80% after deductible!

Thank you! @ CDMC1972 - did you have a large out of pocket expense? So did you just get your insurance & then meet with the specialist you picked? I’m new to this whole thing and it seems like a lot so I want to get everything together. I wouldn’t be doing any of this until Jan…

I use a third party insurance company that I know doesn’t cover it. I was thinking to research and then during enrollment period (November) switching to that certain plan & going from there… theoretically it seems like that could work but I’m not sure I guess.