Out Of Pocket Max....

[littlemiss0428 30]

Im just throwing this out there, but is 4k a "normal" out of pocket estimate amount for this procedure? I spoke with the surgeons office today, and she explained to me that this is my amount that is due PRIOR to surgery.... After I fainted, she explained that the hospital will accept 1/2 payment...(2K)?? I really didnt expect to pay that much... Everyone has thrown in anywhere between $0 to $1500~I called the hospital business line, but no one has returned my Call. My daughter has had 2 knees surgeries, and I never had to pay any more than $250 out of pocket prior to surgery. Is it because the VSG is considered an "elective" surgery? Should I plead with the billing department in paying 25% (1k)? Im aware that the $4,294.77 is my responsibility, but to require 1/2 prior to surgery is way too much! And more than I can afford @ once..Any advice, pleeeeease????

[Joisey01 87]

My out of pocket expense is set by my insurance company at $3,000. I had a car accident in January. I met all but $817 of that. At my final appointment with my surgeon, I had to pay them that $817. Today I had my EGD at the hospital and had to pay nothing. When I get sleeved next Thursday, I will pay nothing.

$4,000 is not an abnormal amount to pay out of pocket in our area. It all depends on what your insurance limits are.

I have learned over time that bariatric surgery is not cheap. My insurance company has deemed the surgery medically necessary for me. I don't consider that to be elective in the least. If I don't have this surgery, I will die. Is that what you consider to be elective?

It's always about dollars and cents. I hope this helps you out even a little. I hope you can work this out and you have complete success!!

[Darkkyss 33]

Sounds like your Dr. is "out of network" so yes sounds normal. Hospital called me and told me mine would be close to $4000.00 but I corrected her and informed her I had called my insurance and since my Dr. was "in network" I had NO out of pocket expense. She argued with me but I had her call the insurance company and she called me back and said Sorry she was wrong.

So yes they want that amount up front 2 weeks before surgery. If there is any difference they will refund or bill you.

My insurance paid for surgery/3 day stay at hospital was over $45,000.00

Call your insurance and ask questions!!!!!!!

[puppyphat 397]

I had to pay AUD$5000 before surgery to cover anaesthetic, surgeon and hospital. Our health system is different to yours, but that is a standard out of pocket amount for over here and must be paid in full prior to surgery.

[ozeedonkee 145]

I will need to pay the surgeon AUD$3500 prior to surgery, and then pay the anaethetist roughly $2000 whenever he sends his bill. And then hope for the best when claiming from Medicare and insurance.

[AliveAgain 283]

My doctor had some services that were not covered by insurance, like his support groups, access to his dietician, plus unlimited* visits to see him for the next five years even if my insurance changes, lose a job, etc. That plus my portion of co-pays, deductibles, etc. put me out of pocket about $6K for the surgery. And yes, most hospitals will ask you to pay up front, and will sometimes give you a discount for not having to go on a payment plan.

[littlemiss0428 30]

Thanks everyone... I really was'nt aware of all the various costs involved. Im going to re-check my policy tonight with Cigna. My surgeon is associated with the hospital and is head of the Bariatric Program, so I dont know why he would be considered "out of network". I can only try... Im in too deep now, so my main concern is coughing up the money (within 6 weeks)... hmmm if its not one drama- its another..

[ArcusX 216]

Your Cigna is better than mine. I figured mine would require 20% or ~ $6k. After reading above, I called. My policy doesn't cover any bariatric surgery, at all. Maybe my doctor offers a deep self-pay discount... or... time to look for a new job.

Hmmm....

[littlemiss0428 30]

Your Cigna is better than mine. I figured mine would require 20% or ~ 6k. After reading above' date=' I called. My policy doesn't cover any bariatric surgery, at all. Maybe my doctor offers a deep self-pay discount... or... time to look for a new job.

Hmmm....[/quote']

That sucks!!! I thought the same thing until I attended the 1st info seminar.. I didnt realize that It's the employer that choses to cover barbarics or not on the policy.

[Patienlywtng on my Curves 73]

I have Cigna as well. I was concerned with the Out of Pocket costs upfront, but the office told me that I would have to take care of that after surgery. I do know that hospital is $350 for in-patient stay up front. So I will work on getting them that beforehand.

Please keep us posted. I am now thinking to call my insurance again, just to be certain.

[ArcusX 216]

That sucks!!! I thought the same thing until I attended the 1st info seminar.. I didnt realize that It's the employer that choses to cover barbarics or not on the policy.

Well, tomorrow is my "clinic day," which seems to be the first real appointment where I'm supposed to meet with the doctor, nurse, nutritionist, etc. I think before they schedule this, they sort do a little pre-appointment vetting, checking my benefits. I'll know for sure then. I'm not holding my breath though.

[littlemiss0428 30]

I have Cigna as well. I was concerned with the Out of Pocket costs upfront, but the office told me that I would have to take care of that after surgery. I do know that hospital is $350 for in-patient stay up front. So I will work on getting them that beforehand.

Please keep us posted. I am now thinking to call my insurance again, just to be certain.

Well I do know that my Hospital stay (on my Cigna card) say $250/Night.... But if the co-insurance, and deductibles are added in and calculated, thats how my "share" for the out of pocket max was 4K... My Hospitals Policy was to pay the 50% prior to surgery..And they are still pretty firm with that! Im sure Im explaining this all wrong (LOL) BUT .. Are you already approved? If you are, then Cigna could give you an explanation, and you can get an idea of what you may have to pay...

[littlemiss0428 30]

Well, tomorrow is my "clinic day," which seems to be the first real appointment where I'm supposed to meet with the doctor, nurse, nutritionist, etc. I think before they schedule this, they sort do a little pre-appointment vetting, checking my benefits. I'll know for sure then. I'm not holding my breath though.

Well, tomorrow is my "clinic day," which seems to be the first real appointment where I'm supposed to meet with the doctor, nurse, nutritionist, etc. I think before they schedule this, they sort do a little pre-appointment vetting, checking my benefits. I'll know for sure then. I'm not holding my breath though.

Actually, My Surgeons team Pre-screened my insurance, and then after it was accepted, they made an appointment. So...How did your appointment go today???

[ArcusX 216]

Well, at my appointment yesterday, the insurance consultant assured me that I am, indeed covered. After asking if she's sure at least 3 times, I think I'm going to go with her version!

[geno5150 168]

Well, at my appointment yesterday, the insurance consultant assured me that I am, indeed covered. After asking if she's sure at least 3 times, I think I'm going to go with her version!

I'd call the insurance company myself and check if you have any doubts. The bill will go to you, not the insurance consultant if she's wrong. Ultimately, you are liable for all the charges regardless of what she says.