Can someone help me understand..penalized For insurance

[narmrn 0]

I just canceled my lapband surgery which was to happen tomorrow. The Bariatric Center repeatedly advertised and stated in their printed literature that the Lap Band Procedure cost was approximately 20,000 dollars inclusive (as an outpatient). When I began the process for having the surgery I knew there was a possibility that I would be a self pay patient because I did not know if I met all the criteria to be covered by my health insurance. As it turned out my employer sponsored health insurance approved the procedure and my surgery was scheduled. I have already paid 2300.00 out of pocket to the surgeon for office visits, his portion of the surgery charges etc. I called the anesthesiology group (no patient balance anticipated) as well as the hospital to make arrangements to pay my co pays the day of the procedure. The Hospital where my surgery is scheduled as an outpatient told me my portion of the charges was to be 5100.00 plus. This seemed like a lot so I asked what the total charges were and was told 66,000 dollars. (This is just the hospital, not the surgeon or anesthesia). I asked how that could be...as I was quoted 20,000 as a self pay patient for hospital, surgeon and OP care. I refuse to have my health insurance billed 66 thousand dollars for a procedure I can pay 20 thousand for. Has anyone else had ta similiar experience? This seems almost criminal to me. I plan to call my insurance tomorrow and see if I can have the surgery as a self pay patient and then I will bill my own insurance....anyone done it this way??

[missmeow 156]

I'm finding that a lot of surgeons charge program fees ($2500-4500) in addition to taking the insurance. Yet, the self-pay is usually $12k-$20k. I don't get it myself and have been considering the same thing.

[thsisme 14]

66 thou is a bit high. Usually from the hospital that covers all medications, supplies, etc...however with that said the hospital generally has a contract with the insurance company and the charges are capped at whatever amount has been negotiated. Usually, this means that the hospital inflates their charges and will only see a portion of it and then they charge you a co-pay based upon your insurance and then in writing will write the rest off.

Why they do it? I am not a finacial wizard, but you are not seen as a self pay when the insurance is paying and usually more and more hospitals are reducing their costs to the bare minimum (some at cost) and then make it up with other means of payor sources. I think self payers are givent he reduced amount due to the decreased amount of labor put into the paperwork and whatever else goes into generating a claim with inusrance companies.

Just my thoughts.....

[melzie_99 22]

Not 100% certain why self pay is so much cheaper, but like mentioned earlier, hospitals have a tendency to inflate prices for insurance companies because they know they're not going to get back 100% of the charges. I think my insurance company only paid about 50% if even that much. That being said, unless you're required to pay a portion of your insurance balance, I guess I wouldn't worry too much about it; after all, isn't that what insurance is for?

[Cocoabean 430]

3 years ago my insurance company was billed $43,000 for my surgery. I doubt they paid that much. What they bill and what they are reimbursed is different. Self-pay is generally much less.

[TKW 501]

Is there any wonder why health care in this country is such a mess! Rediculous! I know they don't get paid what they are actually billing but they sure as heck get more than the self pay. What's the difference?!

[mattie7632 24]

It is criminal and this BS happens ALL the time, regularly.

Insurance cuts doctors fees so they don't get paid ENOUGH by many carriers, so the doctor has to have a higher fee for insurance companies that will pay fairly,

and cash patients, to carry the business. Also, insurance will cut doctor rates every year if the geographic average fee is not high enough, so doctors fees MUST be high just to

avoid insurance from cutting their fees even more!!! No doctor could survive if all carriers cut rates this much, or down to Medicare rates, for example.

Twisted, yes. Legal? Apparently. Welcome to National Healthcare. If it continues, you won't be able to find a good doctor working for this kind of pay in 10 years.

If insurance would just f'ing pay a percent of a REASONABLE rate these games wouldn't happen. But they won't, profits are more important.

However, with that said, $66,000 does sound high. But depending on your state, county, etc. it could be right. I would ask to see the itemization to see if something looks like an error.

[HeatherinCA 10]

Self Pay should be like 13-20k I'd think, we were looking into that before I changed insurance companies... not sure about all the other fees. (anesthesiology and stuff)

Insurance after discounts and stuff don't end up paying the full amount I don't think. I ended up paying about $3000 out of pocket with insurance

[Acadia 20]

My surgery was $50,000 total ($49,000 and change so I rounded up).

The allowed amount by my insurance company was $28,000.

Of that allowed amount, my insurance paid $25,200 and I paid $2,800.

So chances are the self pay would have been $28,000.

If you go self-pay you'll very likely pay at least $10,000 more than you would through your insurance.