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

[mommy794 119]

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 !

[ProudGrammy 8,322]

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 bill Hopefully things will work out for you

Kathy

DOS 12/15/11

[Lissa 2,631]

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!!

[mommy794 119]

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!

[ProudGrammy 8,322]

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

[mommy794 119]

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 I have BCBS blue edge as primary and BCBS anthem as secondary. Keeping my fingers and toes crossed!

[AKMama 36]

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.

[mommy794 119]

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!!!!

[mommy794 119]

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

[DisappearingDivis 36]

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!

[mommy794 119]

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!

[vsgm 31]

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!

[mommy794 119]

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!!!