Blue Bug

The surgeon's office gave me the figure of $20,000 out of pocket with insurance. She explained it like this: If they bill the insurance, it costs way more because they have negotiated rates with the insurance companies, and everything has to run its course through billing, etc. and that they may wait up to 6 months to get paid.....whereas if I pay up front the surgeon and the hospital give me a huge discount because they get their money right away! - I know, not a good scenario.:thumbdown: I guess if they bill the insurance, it costs something like $32,000. Anyway, good luck to you. I'm glad your insurance will pay more.:wub:

Thanks for putting into words exactly how I feel - I felt like I had seen a light at the end of the tunnel and someone slammed it shut too. :sad_smile:My insurance will only cover $7500 lifetime maximum, and from what the surgeon's office told me, there's no way I can afford it. They said my out of pocket for the surgery could be more than $20,000 plus all of the fills, etc. At least your max is double what mine is, but I would ask the surgeon's office specifically what they think your out of pocket expense will be (including fills)...That way there are no questions down the road. Good luck to you.

The best way to find out is to call them. I have Anthem BCBS. My state is CO, and the guy on the phone was really helpful. They can tell you specifically about your plan if you call and give them your ID number, etc. Unfortunately for me, my insurance has a max. lifetime payout of only $7500. Hopefully yours will cover more. Also, some employers exclude bariatric surgery all together on their plans. Hope this helps......

I never got that far.....the surgeon's office called me and told me Anthem will only cover $7500, and if they bill it through the insurance it will be $32,000 and that I could end up with $20,000 or more out of pocket. Then they told me I should just self-pay the $13,000 and do it that way ---There's no way I can come up with that right now (yeah, I've got $13,000 just laying around...NOT!). I am totally bummed! :cry_smile: They DID say it should be no problem to get the approval from my insurance though (even though it will do me no good). So I just got $1300 worth of lab work done for nothing! I guess I'm gonna have to try to lose the weight on my own once again. I cried at first, but now I am resolved to it and trying to keep a positive outlook and stay motivated. After spending Christmas with my mom and seeing what years of being overweight has done to her body, I know I need to get this weight off before it destroys me too. Wish me luck. To all those out there who have insurance companies that will cover the real cost of the surgery, you are VERY lucky, and I wish you all the best.

I have Anthem Blue Cross too...this is good news for me. I am awaiting approval now. Just went for the consult yesterday. I am hoping that my out-of-pocket expense will be do-able for me.

I'm so sorry. I know how this feels, as it happened to me a year ago....it was a line item exclusion on my husband's employer's insurance. Since then my husband switched employers and has Blue Cross, so it's covered now, but I'm waiting for approval. I definitely feel for you!!!!! There's no WAY I could do it without insurance. I'm still waiting for approval and hoping I will get it....then hoping I can afford the out-of-pocket expense even after the insurance! Sorry :eek:

I would ask both doctors at those 2 visits to document everything about your weight loss "plan" when you visit and mention that they placed you on a diet. That way you can use it for the 6-month supervised diet. I do medical transcription, so I'm thinking as long as they document your weight and specifically state that they put you on a diet in your chart, you can later submit those charts as evidence you have been on a supervised diet for this time frame. Good luck!

I went for my consult today, and everything went great. If all goes well, my surgery date should be in March. All of my pre-op testing is scheduled for January. I'm so excited!