Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Approved For My Gastric Sleeve Surgery But How Much Should I Be Expecting To Pay Out Of Pocket?



Recommended Posts

I was approved back in November after 4 months of monthly visits and now I'm in week 7 of 10 week online program for total of about 6 months. I called today and asked and bariatric center said they would have to call and verify it and call me back but I have a 70/30 plan. Now I'm freaking out that I may have to come up with several thousand for my portion. I just don't know if I can swing that.... I will be severely disappointed if that is the case. I may be able to he a loan or financing but I'm really hoping its no going to be as much as I'm fearing ... Any ideas on this or your experiences ??? Thanks !

Share this post


Link to post
Share on other sites

hi mommy794

glad you've been approved, that's the first step. As far as the 70/30 wish i could tell you more.

here's my experience though. i have medicare as my primary. They don't allow the sleeve. Bill from hospital can't be sent to medicare til after surgery. so i go into surgery blindly. after medicare officially denies the sleeve, hospital bills empire (my secondary insurance) beurocracy (msp). I've spoken with empire "many times" and they can't guaratee (msp)anything but they "think" i'll be approved.

So 70/30 sounds good to me if i'm not approved, i foot the whole billsad_smile.gif Hopefully things will work out for youpeace.gif

Kathy

DOS 12/15/11

Share this post


Link to post
Share on other sites

I was self pay and paid nearly $13k out of pocket. I advise talking to the hospital and surgeon and findng out what the worst case scenario is if you have to pay 30% of the cost. Then you can apply for a loan somewhere just to make sure you have your portion covered. There are tons of options, a bank loan, line of credit on the house (if you own), perhaps a loan from a family member. Last resorts are using credit cards or a medical loan (like Care Credit) for your portion. The hospital and doctor might even let you make payments before or after surgery to cover your portion. And, you might get incredibly lucky and they accept your insurance payments as payment in full.

Don't let this be the reason you don't get surgery, especially after you've jumped through hoops for approval. As I always say IRL, there's more than one way to skin that cat. Although I've never figured out why anyone would want to skin a cat.... ;)

Good luck!! :)

Share this post


Link to post
Share on other sites

Well after looking at my insurance benefits myself...and having a small heart attack bc the surgeons office called me on Thurs. and said my portion was gonna be 8k... then like I said looking at my benefits myself says IF I use the facility/company that I work for which has a baritric center as part of the hospital that it covers 80-20% and that my max out of pocket is 2500... I was like YESSSS much better. So I'm gonna call the insurance co. myself Monday and confirm all this and then I will Sch. for Jan 30THHHH yayyyaaa!

Share this post


Link to post
Share on other sites

hey mommy794

Congratulations - i'm so very glad the money thing worked out better. 80/20 is better than you thought it would be.

Its almost New Year now - so January 30th is right around the corner. To a great new year, and a healthy life, today, tomorrow & always

kathy

Share this post


Link to post
Share on other sites

AHHAAA this ins malarkey is driving me NUTSSSS!!! I am going to the surg office Monday and try to get them to pin it down. I hope they will take the ins payment plus my 2500 out of pocket max...which apparently according to the rude lady I talked to at BCBS doesn't apply to bariatrics. She said it's 70-30 no matter what with a cap of 13k that BCBS will pay. Needless to say if the surg. and facilities are way too high I doubt I will be able to get this done jan. 30...possibly postpone or maybe not at all depending on fees.... which will REALLLLLY suck since I have been working on this since june 28. I actually have a secondarly ins. thru my husband and they are supposed to send a letter saying what criteria I have to meet for them to pay anything.... so maybe between the 2 I MITE be able to afford the rest...we will see sad.png I have BCBS blue edge as primary and BCBS anthem as secondary. Keeping my fingers and toes crossed!

Share this post


Link to post
Share on other sites

I have BCBS-Fed and my out of pocket is 5000.00, which I am now trying to find financing for. I believe I am going to try the CareCredit line and see how that goes. It seems to me to be a huge difference between the insurance companies. Good luck it can agravating just trying to figure out a total. I didn't get a number till I was approved for my surgery.

Share this post


Link to post
Share on other sites

I have been "approved" since Nov. but its still a long annoying process to get to the final result...but it will be sooooo worth it!!!!

Share this post


Link to post
Share on other sites

FINALLY!!! So my surgeon called me right after I posted the last post and said they are going to make sure that everything is taken care of and I'm not going to get stuck with thousands in OOP expenses. I actually work for the hoprital system where I'm having it done and he said "our" insurance is the most frustrating to deal with and get concrete answers with. So that makes me feel SOOOO relieved and much better...now I am SCH. for Jan. 30....whewwww finally!!!! yay

Share this post


Link to post
Share on other sites

Sorry for all your Ins. drama mommy794. But BCBS is such a pain in the but to deal with! I have BCBS of IL and they covered 100% of the surgery. That is after months of denial letters and phone calls. Good luck and don't give up!

Share this post


Link to post
Share on other sites

FINALLY! insurance is all situated, and now my promary and my secondary have both approved me...this is a BIG relief since my surg. is sch. for 2-6 YIPPEEE ! can't wait!

Share this post


Link to post
Share on other sites

Mommy794 that's awesome that it all worked out for you!!!!!! Congrats!!!! It IS so frustrating trying to get the insurance part figured out - - after starting the process in June when I had Aetna that covered very well, on January 1 my employer changed insurance to BC/BS Anthem which has a very high OOP cost. I tried like crazy to rush the doctor/hospital/other insurance company, but of course Dec 31 came and went. Then on January 20th I was approved by Anthem. Yippie. I say that sarcastically but realize I'm fortunate to have insurance that'll cover anything. Now I just gotta figure out how I can do the OOP and if maybe the hospital/doctor would accept the insurance pymt as near full. that'd be awesome. So I'm thrilled for you that yours worked out!!!! You're almost there!

Share this post


Link to post
Share on other sites

My secondary is bcbs Anthem and it only took about 2.5 weeks to get approved. I had been dealing with getting my ins. approved since July and really didn't think my 2nd would cover any thing at all...so I was pleasantly surprised! I hope they will take ins. as paying most of yours as well. I know alot of places and surgeons DO take ins. as payment in full or close to it if your ins. has a contract with them... it is so annoying but will be worth it in the long run!!! GOOD LUCK!!!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

    • Jenopolis

      Had a sleeve in 2017, lost over 100 pounds. Had a DS surgery this year (2025) for more sustainable weight loss. 🤞
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      The 14th was my day. I am home and recovery is going pretty smooth. They even let me walk out of the hospital. Picture of me in recovery curtesy of my boyfriend lol. 

      · 3 replies
      1. DaisyChainOz

        Glad it went well!! Wishing you a speedy recovery and wonderful success!! 🤗

      2. buildabetteranna

        Thank you ❤️

      3. Selina333

        Neat you have a pic of this day! I was sooo happy to get my surgery. It was well worth it! And I'm not even near my goal. I had surgery Dec. 2!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×