questions

[im2shy2tell 14]

So it is almost time for me to submit all my paperwork to Aetna. I am having surgery with Dr. Macik in Atlanta. I am having the sleeve.

Can anyone give me a general ballpark figure of how much the gastric sleeve costs?

I have Aetna Aexcel. I have to pay twenty percent. I know I have a 550 deductible. Is this 20 percent before or after the the surgery? I am trying to figure out how much I have to save up before I get approved and get excited about a surgery date. The 550 is easy. It's the 20 percent that is stressing me.

[Kimmes 38]

Ok I can help you here - I am in insurance.

First you pay your deductible. Then you pay 20% - they pay 80% up to the out of pocket maximum - you did not say what that was. And then they pay 100%.

Are you scheduling this for this year or next? The out of pocket maximum is the most you will pay as long as your doctor is in the Aetna network.

Let me know if you need any more help!

Kim

[im2shy2tell 14]

My max is 3000. I was wondering if I had to pay that before or after surgery. Why pay a deductible if you have to pay the 20 percent before. Do you know how much the procedure is?

Ok I can help you here - I am in insurance.

First you pay your deductible. Then you pay 20% - they pay 80% up to the out of pocket maximum - you did not say what that was. And then they pay 100%.

Are you scheduling this for this year or next? The out of pocket maximum is the most you will pay as long as your doctor is in the Aetna network.

Let me know if you need any more help!

Kim

[Kimmes 38]

NOrmally they wait until after surgery because the isnurance company will apply discounts etc to the amount the doctor bills. If you want to call me cell I can most likely help you in further detail to understand your coverage. I will send you a message with my number.

[Kimmes 38]

Ask your Dr's office insurance person to provide you with an estimate cost. You pay after surgery and after the insurance company has processed everything for payment. They will send you an Explanation of Benefits that will tell you your exact responsibility -or amount you owe. I have no idea how much they might charge... here in Minnesota is can range from $14,000-$17,000.

Kim

[M2G 1,836]

It is frustrating "shopping" for medical procedures isn't it? My husband and I are both having the sleeve (my turn this week, his *hopefully* in Dec.) and we have a High Deductible Plan, that is ever-so-confusing!

We have a family of 4 on his plan and we need to pay $5K out of our Health Savings Account to hit our "deductible", then apparently our insurance (we have UHC) will kick in and pay 90% (we pay 10%) of every bill submitted AFTER we reach our deductible. To be perfectly honest I don't actually know what the negotiated rate will be for each of our surgeries. I know the self-pay price for my surgeon is $20K. I'm hoping that the insurance has negotiated a lower rate, but I really don't know what that exact cost will be. Then you factor in that I have done all my pre-op stuff already, and I'm sure that self-pay price of $20K includes all the pre-op, but since we've already paid for all of that, the cost would naturally be lower.

Sorry I doubt this is helpful. Just wanted to say that I know how frustrating it can be trying to figure out the nickles and dimes when it comes to insurance.

[im2shy2tell 14]

I was approved. i am getting sleeved 02/09/11

My max is 3000. I was wondering if I had to pay that before or after surgery. Why pay a deductible if you have to pay the 20 percent before. Do you know how much the procedure is?

[im2shy2tell 14]

kimmes, thank u again. im doing wonderfully