Cost With Insurance

[StartingANew 0]

I was just wondering about how much people with insurance are paying out of pocket. I have spent a lot of time research the Lap Band and decided which doctor I wanted to proceed with. I attended a seminar recently where they provided an anticipated expense form. It was $1900 - $400 for psychological evaluation, $500 for program fee, and $1,000 for three year after care (includes dietician, exercise program, and year member to Curves for women). I knew that in addition I would have a $1,000 "access" fee from my insurance. To me that adds up to $2,900. My hubby and I were ready for that :thumbup:. So I get to my first appointment and they provide me a detailed break-out and there is an additional almost $5K for an non-network 2nd doctor. :ohmy: I made the comment that it was weird that he was out of network. It was then explained that he didn't except any insurance:glare:. So the $2,900 is now over $8,000 with miscellanous fees.

My health is so worth it but I'm wondering if I should be looking around a little more. There is another doctor in our area (at Scottsdale Bariatric) that has been highly recommended. On the other hand fees like this might be normal. If you don't mind could you please share a rough estimate of what your surgery cost/will cost?

Thank you so much!

[adagray 1]

Hey, I just got my lapband at Scottsdale Bariatric on 12/17! They told me that they will always use assistants, anaesthesiologists, etc. that are under your same insurance or let you know ahead of time. I had no surprises. Between everything, I ended up paying $2k because that is my 'max coinsurance' (aka 'max out of pocket') for the year. So, that includes two sleep studies, all the pre-op testing, dietician visits, etc.).

Just gotta make sure they take your insurance. I was lucky that they took Aetna last year (that is what I have), but I just got a notice that Blackstone dropped Aetna as of this January. I don't know if the other surgeons she works with (Sprunger and Hondanas) take Aetna, though... something I still have to follow up on. The price at SBC includes 1 year of aftercare (all the dietician visits and fills you need) so I won't have to worry about this until the end of 2010.

Then, if none of them take Aetna, I gotta decide whether to pay the 'out of network' rate or find someplace else to get my fills done. I love SBC, though, so I would probably pay the 'out of network' charges at that time (seeing as I shouldn't be needing a lot of additional fills after a year anyway - hopefully!).

BTW, I had a great experience w/SBC. I could go on and on. I love Dr. Blackstone and her assistant Melissa, the dieticians, psychologists that run the support groups, etc. I love that there is no long pre-op or post-op liquid diet... you eat real food up until the day before surgery and are back on real food 4 days post-op. The hospital (SHC Shea) is great and has its own bariatric wing so all the nurses are very experienced w/taking care of WLS patients and they have all the proper large size equipment.

[PalmBayTish72 4]

I am very fortunate that according to my insurance company, BCBS, I have already met my deductible and out of pocket maximum for the year (which ends 3/31). That means that there will be no additional charge to me for the surgery. This past August, I had to have emergency surgery and with the amounts paid to my doctor and the hospital 6 months ago, I don't have to pay any additional. Had I not already had those expenses or had the surgery after March 31st (when the new year for my insurance begins), it would have cost me $1500 for my deductible and $3500 for out of pocket...

That being said, the only costs I have incurred were for my 2 hour visit with the psychiatrist at a cost of $350 (she was out of network), but that also includes 3 more visits with her post surgery. The visit with the dietician and the surgeons consults are covered in the cost of the surgery. I paid no "program fee". If I paid out of pocket, it would have been broken down like this:

"If your insurance does not cover it the total cost of the Lap-Band surgery is $13,050 and includes one year of free adjustments, office visits and support group follow up. This total includes the following: surgeon's fee, anesthesia, psychology consult, nutrition consult, and the hospital fee."

Edited February 7, 2010 by PalmBayTish72
added more information

[Dana36 0]

I have Cigna, and had my surgery done at Memorial Hospital in Chattanooga TN. I paid $95 for my psychological and nutritionist ($95 total), then $30 copay for my pcp and surgeon visits ($30 per visit). And that was it. My insurance paid 100% of everything else. I refused to go somewhere that would have made me pay a program fee. This is a medical procedure.. how many gallbladder surgeons force a program fee on you??

[Gone23456 0]

I did my 6 months supervised diet along with my 3 psych visits last year so I paid for all that out of pocket. Well, I used my flex spend account actually so that was nice to have.

Insurance was approved on December 18, 2009 so we scheduled for January 27th so I could do all my pre-op visits in January so everything would come out of this years insurance. I will have to pay my $1500 deductible and $4000 out of pocket max. So for a grand total of $5500 I get a new lease on life!

[StartingANew 0]

Wow, thank you so much for all the responses. I really appreciate you taking the time to answer :thumbup: It sounds like my first thought of looking around is a good one.

Adagray thanks for the extra in-sight into SBC. I have a friend whose mom had surgery there about 14 months ago and she raves about it. Specially that Dr. Blackstone is amazing!

I think I'll schedule some time with them soon. I have BCBS of Arizona as primary insurance and TriCare as secondary insurnace. The last time I checked they accepted BCBS.

Thank again!

[BetsyB 9]

There was a $300 fee to the surgeon's office for their nutrition/exercise program. $35 copays for office visits. And, depending on whose surgical bills make it to the insurance company first, a deductible. Our max out of pocket for the year is $4,500 for the family, I think---so between this and my son's tonsillectomy, which was done 2 days after I was banded, we should be medical bill free for the rest of the year.

(My husband has serious health issues, so getting to the max never takes long; this is the first time I've contributed to it significantly, though.)

The out-of-pocket expenses for the surgery are purely those outlined by our insurance policy--no surprises.

[kagead 0]

I know this doesn't apply to most, but it may help somebody else down the road:

I am self employed and have an individual policy with BCBSIL. (Lap-band is covered!) My office copay is $30, my annual deductible is $250, they pay 50% for psych services and I have a 20% coinsurance payment on most procedures. IIRC, I have a $3000 max out of pocket.

I am going through Northwestern Memorial Hospital in Chicago and there is no "program" fee.

I started this process in November, and so far, I have spent about $750 out of pocket for the psych eval, upper GI, EEG, 1 nut meeting, 1 nut class, and meeting with program director. (The one on one meeting with the nutritionist and the 3 nutrition classes are not covered at all.)

Now that it is a new year, I'll have to meet my deductible and still have 2 nut classes, all my blood tests, my annual exam with my PCP and the surgery itself, of course. I am hoping to do it outpatient (I live about 10 minutes from the hospital) to avoid the cost of an overnight stay.

I'm guessing my total OOP will end up somewhere between $3 and $5,000.

kagead

[btrieger 21]

I've had a total of 8 visits to my surgeons office including nutritionist and behavioral meetings. With a $20 co-pay each time. That's $160.

$20 co-pay for psych.

$20 co-pay each for 2 sleep studies.

Up to $220 now.

$300 for 3 weeks worth of Optifast.

I guess the grand total is $520 so far and I am not banded yet.

[MissCherita 0]

OKAY! I have Aetna the Bariatric max is $10,000 for my policy. I ended up paying my doctor's office $1,300. Then I went to the hospital for my pre-op and I was hit with a bill for $11,650.. Yeah I know! That's the cost of a whole new band. BUT apparently thats the hospital fee's..

[parisluver 1]

I would certainly challenge the hospitals fees. Over $11,000 for pre-op? What did they do? Were you admitted? Hospitals are NOTORIUS for overcharging. They have contracts with insurance companies but gouge people who are paying cash unless they negotiate.

I'm still waiting to hear from my surgeon's office to determine what my out of pocket will be. I have Cigna and the max is $2000 for the year. So it won't be more than that.

[PalmBayTish72 4]

I would definitely question the hospitals billing, especially since you have insurance. My surgery, if I had been a self pay, would have been a TOTAL of $13,050.

Hospitals will rob you blind. I was admitted to the hospital back in August for emergency laproscopic surgery for an ectopic pregnancy and my surgery took 20 minutes. I was there for a total of 3 hours from admission to release, yet they billed my insurance for a full FOUR day stay for a cost of over $15,000. Needless to say, I clued in the insurance company that they were being screwed and they had the hospital resubmit a bill which was a 1/4 of that cost.

Definitely contact the hospital and your insurance and find out why you are being charged so much and make sure you have every invoice, every phone call and every name of who you talk to documented.

best of luck to you!

[valleygirl806 0]

I have a similar situation....I'm in my fifth month of the medically supervised weight program and my coordinator called me last week and informed me that I would have to pay $7,000 out of pocket...my insurace has a max of $25,000 for WLS....the cash price is only 13,000 so I'm trying to understand why are they trying to collect $33,000 from me and my insurance company? We pay over $200.00 per month for health insurance that we barely use and I feel like I shouldn't have to pay extra for this surgery....my out of pocket max is 1750.00 so I just don't understand how the hospital can charge me so much for an out patient laproscopic procedure....I didn't pay this much to have both of my children by c-section with two overnight hospital stays each...it seems like the hospitals are exploiting this whole process for overweight people its just has a ring of unfairness to it...

[Manda87 3]

I would get a second opinion, and it looks like you're going to. I just got a bill from the hospital where I got all my pre-op tests done: Upper GI, EKG, Chest x-ray, and labs. The total balance was $2,212. Blue Cross picked up $1,718.542, and my responsibility is $493.48. I also paid for my nutrionist appointment which was $55. My original consultation was a co-pay of $20 and the psych eval's co-pay was $20. However, for the total surgery, I was quoted $2,050. So, it lookes like a little over $2,500. I hope it stays that much, and I wouldn't mind it going lower! lol

[parisluver 1]

I have a similar situation....I'm in my fifth month of the medically supervised weight program and my coordinator called me last week and informed me that I would have to pay $7,000 out of pocket...my insurace has a max of $25,000 for WLS....the cash price is only 13,000 so I'm trying to understand why are they trying to collect $33,000 from me and my insurance company? We pay over $200.00 per month for health insurance that we barely use and I feel like I shouldn't have to pay extra for this surgery....my out of pocket max is 1750.00 so I just don't understand how the hospital can charge me so much for an out patient laproscopic procedure....I didn't pay this much to have both of my children by c-section with two overnight hospital stays each...it seems like the hospitals are exploiting this whole process for overweight people its just has a ring of unfairness to it...

This doesn't sound right. I would contact the billing department of the hospital and explain what the coordinator said to you. Then I would call your insurance company. Ask for everything in writing. Ask the coordinator to provide all the charges and fees to you in writing. Hospitals are extorting money from people left and right. It just isn't right and is a major reason our health care is skyrocketing.