Insurance Issues *need Advice

[seattle93 0]

Hey everyone,

I've been lurking on the site for some time now and decided to join for support. I'm currently finishing my last 2 months on a 6 month supervised weight loss plan. And the journey so far has been pretty smooth but now I am running into bumps. Up until this point I have been told my insurance covered the VSG. But I did not know how much? Yesterday I found out 50% this was a huge blow. I have money saved but not enough to cover the other half. My question is can I ask my insurance to make an exception and cover more than half? What should I do I'm 20 yrs old and have no credit..so loans might be difficult and only been working at my job for about 6months.

Thanks

[innerme 26]

Check to see what your max out of pocket is for the year. You might not end up paying as much as you think you will. Mine is $2500 for the year. I had already spent $1700 before my surgery. I have yet recvd my bills but I already know that I will have to pay only $800 more dollars to hit my max and who I pay will be determined by the insurance company on who filed the bill with the insurance first. Once my max out of pocket is hit for the year my insurance picks up the balance for the remaining of the year.

[Erin6573 10]

Also, most facilities will work with you on a payment plan if you can't pay it all up front. If your insurance is going to cover 50% and you have some saved, go ahead and pay what you have when the bill comes in and then call the hospital or whoever you are getting bills from and ask them to put you on a payment plan. I had to do that after my son had surgery and I was hit with an unexpected $1000 bill that I did not have the means to pay at the time. They gave me a very reasonable plan and I was able to pay it off in a few months. I guess it will all depend on whether they will require the money up front, but most facilities will bill your insurance and then bill you for the rest.

[seattle93 0]

Thanks for all your input! I'm kinda leaning towards making a payment plan with the hospital. I really don't want to get trapped with loans.

[former_vbg 198]

Thanks for all your input! I'm kinda leaning towards making a payment plan with the hospital. I really don't want to get trapped with loans.

A word of caution though. Your insurance carrier will have a contracted rate for services that you receive which will help you, but I'm just going to share my experience so at least you have the information.

I had my surgery down in Dallas, 2 overnights in the hospital, no complications whatsoever... Just the hospital bill alone sent to Aetna was a bit more than $83,000... that doesn't include the surgeon's bill, anisthesiologist, meds, bloodwork and all kinds of other misc. other things they came up with. The contracted rate with Aetna meant that my ins. company ended up paying I think it was right around $52K or $53K to the hospital bill. I don't recall about the others off hand. I used IN NETWORK hospital and doctors too.

Now, if you have a maximum yearly out of pocket which you should, then once you hit that, it doesn't matter whether your surgery costs $1 MILLION dollars, BUT.... you need to sit down and write out a bunch of questions about this and call your insurance company. Document who you talked to, when you talked them, time, etc... I realize you are young, but no time like the present to realize the importance of CYA (cover your @ss).

Ask the customer service rep for documentation either to be mailed to you or online links on their site that clearly outlines your responsibilities for payment. Have the CPT code (someone else might know it here) when you call so that you can be as specific as possible.

I just hate to see you end up getting bills for several thousand dollars after the fact and then its too late to do anything about it. That would be a crushing experience!