Approved! Cost Questions?

[Dearinger 0]

So I have been lurking around the forums for months now, and now that I am coming close to surgery I thought I would ask a few questions.

I had my final nutrition appointment yesterday (6 month required for insurance), and my case worker submitted my information to UHC this afternoon. I got a call about an hour ago from my insurance company letting me know that they have approved my surgery!! I called my case worker and she said that was the fastest she has ever received an approval (less than 2 hours after submission). To give some background for comparison, I am 29 years old (BMI 51) and have no co-morbities at all. I don't even have high blood pressure, the surgery is more about prevention than anything else.. The woman from the insurance company asked that I mention the quick approval to my companies human resource department?? I didn't understand why, I assume they have had problems with them in the past? My company is huge and the human resource department is in California. Anyway, I don't mean to brag, I am just super happy!

My question is this: I was told that my insurance company covers the cost of surgery at 100%. My deductible is 500 dollars (which I've already met 200 of that). I've never had any surgery before and I don't really know how much I will be paying? The woman who originally took my information told me that I wouldn't have to pay anything.. is that possible???

Thanks for your help!

Dearinger

[cookies 56]

It would depend on your policy, I suppose. You may need to get it out and dig through it. If you've met $200 of your $500 deductible, that would mean you have $300 of your deductible remaining, which you will definitely have to pay.

The question is whether you have an 80/20 plan or something like that. If you do, the insurance will pay 80% of the surgery costs and you will be responsible for 20% of the rest, up to a specific out-of-pocket maximum.

It's possible you just have 100% coverage in which case...woo hoo!

[Vance_ 217]

First off, CONGRATS AND WELCOME!!! That is awesome!! And my goodness...2 hours?!?! That is fast!!

If they say it's 100%, it's 100% minus your deductible! That's awesome!!

Again, congrats!...and keep us informed!!

[Jenn31MA 149]

If its 100% then you should only need to pay the $300 you have left to meet your deductible. I wish mine was $500!! Congrats on the quick approval

[GivingItMyAll 168]

Congrats on the fast approval!

[vivienvixon 1]

Wow! Congrats I to have UHC and am about to submit my info. I so hope I have the same outcome us u!

[Wheetsin 714]

You will have to pay the remainder of your deductible. After that it should be covered at 100%. (Sounds like you don't have a coinsurance plan). If you do have coinsurance, you will have some additional costs but there's no way of knowing what they would be without knowing your coinsurance percentage, costs of procedure, etc.

Here are my costs for example. I don't have a deductible nor coinsurance, I just have a copay. My copay for inpatient treatment is $250. My surgery cost me $250. I have a $20 office visit copay, so each visit to the psych (2 were required) cost $20 each. My surgeon's office visits were all included in the $250.

So at this time my total out of pocket is $290.

[Lisa's Hope 421]

You guys are so blessed to have an insurance plan that will cover your surgery. Our insurance through our employer has an exclusion. I have pay 17,000 out of pocket. I get nauseous thinking about it. All of our savings everything I'm using for this surgery and if something goes wrong, I don't know how we will pay for it. I just have faith in GOD and try not to worry. I know that I have to have this surgery and I know there isn't any other way. It is such a shame when the premium for insurance is 1200.00 a month and they can exclude anyway. I have co mordibities. HBP and borderline diabetic. Just can't understand why??

[IowaAndy 95]

Wow,,,,,congratulation on your rapid approval. As for you insurance if you have a $500 deductible then you would pay the first $500. You say that you have already pain $200.....curious as to what you paid this for. You office copays or visits to the psych do not count toward this. Also remember that post op you have a global period after your surgery. This means that any visits to your surgeon for approx 90 days you will not have to make any office copays. After that time period you will be back to paying your regular copays. I would call your insurahce company and they can tell you exactly how much you have paid toward your deductible and what the cost will be to you out of pocket. Best of luck on your surgery.

[IowaAndy 95]

I agree that those who have insurance policies that cover WLS are very lucky. My insurance refused to pay for my lapband removal or for the sleeve. Here in Iowa they wanted $40,000 and this would have had to have been done in 2 seperate surgeries 3 months apart. Well there was no way that I could afford that kind of money so I had the band to sleeve revision in Tijuana, Mexico for $6,000 and I have not had any problems since the surgery. I would do it again in a heartbeat. I know that I could not have been able to afford $17,000 either and would not go that far into debt.

You guys are so blessed to have an insurance plan that will cover your surgery. Our insurance through our employer has an exclusion. I have pay 17,000 out of pocket. I get nauseous thinking about it. All of our savings everything I'm using for this surgery and if something goes wrong, I don't know how we will pay for it. I just have faith in GOD and try not to worry. I know that I have to have this surgery and I know there isn't any other way. It is such a shame when the premium for insurance is 1200.00 a month and they can exclude anyway. I have co mordibities. HBP and borderline diabetic. Just can't understand why??

[vsg30815 99]

WOW! I wish mine was 100% ~ my copay is $3000, but well worth every penny I'm going to fork over next week to get my life back! Congrats ~ that was REALLY fast on the approval!

[Wheetsin 714]

The insurance coverage was a pleasant surprise. I knew I was not excluded, but I was also being asked to prove something that's virtually impossible to prove. I appealed a denial and was approved, then our insurance changed to I had to start over. I started over with everything submitted to overturn the denial and was approved on the first try.

My approval came in February. If I had not received approval by March 1, we were going to pay out of pocket (my surgeon of choice charges $12K for sleeve). We are financially comfortable and it would not have been a hardship for us to pay out of pocket, but there's no doubt that I'd rather not pay it if I had a choice. DH had already conceded that it would be a birthday present I was not allowed to expect him to beat next year!

I was at my surgeon's office today and someone was complaining about having to pay a $45 copay for the surgery. I guess it's just proof that you will never please everyone.