Insurance Advice?

[linkybo 27]

Hi All-

I am lucky enough to have great insurance, but they require a 6 month diet/fitness at a location that I just can't do. So, I decided to go ahead and self pay. Ugh. 20k here in Seattle.

When my surgeon did the endoscopy, he found a hiatal hernia that he's also going to repair. I talked to my insurance company to see if they'd cover the hernia repair that was being done at the same time. They told me they'd cover that, plus the anesthesia, hospital room, etc - anything related to hernia repair. Whoo hoo! Right?

I called the surgeon back and the insurance person there says it's still 20k, that they will bill my insurance for the hernia repair but it doesn't change anything because the surgery is actually more than 20k and they are giving me a price break because I'm self pay. Anytime I see my insurance paperwork, the in network providers (which my surgeon is) always gets a huge discount. I can't imagine they'd lose money by charging a self pay person less than the surgery costs.

So - what do I do? The insurance specialist at my surgeon's office pretty much shut me down and said I have to pay the 20k. Help!! This doesn't seem right.

[Disneytikifan 21]

You can shop it in the US or overseas for cheaper rates. I am paying out of an MSA so it counts as self pay and it is costing me 12k. It is a good deal since it is my local hospital and I know all the docs. You may be able to find a cheaper deal at other US locations, certainly can overseas.

[linkybo 27]

Thanks for the idea, Disney. I'd really like to stick with my surgeon. Everything is lined up for next week. I'm just confused with what the surgeon's insurance person told me. Basically my insurance company is telling me they'll pay for anything related to the hernia repair, but the person at my surgeon's office who is doing the billing says she won't even bill them.