Unbelievable charge for VSG to my insurance

[kj44 215]

Same crap here! They were billed over 75000 when I was quoted 8-10 thousand. Also keep receiving bills even tho supposedly my out of pocket yearly max is 3000. I call BS***

[nyorker 67]

Ok the hosptial charged 66,000 to blue cross/blue shield lets see how much they pay..

Dr charged emblem health ( GHi). And they only payed $1175. Doesnt make sense the Dr would do this for only $1175. He must get a piece of the hospital payment..

[nyorker 67]

Forgot anesthesiologist will probably bill GHI also. Watch this bozo say it was out of network and you have to pay. Lol i even asked her hey before you put me out do you take GHI said i work for a group i dont know what they take lol.

[Kindle 8,667]

Not that I'm defending the excessive hospital charges in anyway, but part of why they have to charge so much is to make up for all the deadbeats that don't pay a dime. For example, I have a "friend" that has had breast cancer and lymphoma. He travelled to three different states to scam free surgeries and chemo from several different Hospitals. His bills have exceeded 1/2 million dollars and he's never paid a penny. He's had at least 1 community fund raiser for medical expenses that raised over $15,000. Since he figured he owed so much, that money wouldn't make a difference so he used it to buy a new truck instead. Scumbags like this is partly why hospitals have to charge so much for the people (and insurance companies) that actually do pay.

[faifie 13]

All medical providers have to bill what is their usually and customary rate and the the insurance companies pay what rate they have contracted with the provider. But the bill has to show the higher U/C rate.

[Daydra 345]

You should really check that out, that seems like they shouldn't have billed both insurances, I'd ask them why they thought they should bill both.

That's just the way billing works for those that are dual-insured. Company #1 gets billed the full amount first and pays whatever is in their contract, and then the balance gets billed to company #2 and they then pay according to their rules. More often than not, the secondary insurance picks up everything that the patient would have have been responsible for otherwise. I have insurance from my employer and have secondary coverage from Tricare Prime (hubs is military). I almost never have any out of pocket costs, whatsoever.

[Daydra 345]

You should really check that out, that seems like they shouldn't have billed both insurances, I'd ask them why they thought they should bill both.

That's just the way billing works for those that are dual-insured. Company #1 gets billed the full amount first and pays whatever is in their contract, and then the balance gets billed to company #2 and they then pay according to their rules. More often than not, the secondary insurance picks up everything that the patient would have have been responsible for otherwise. I have insurance from my employer and have secondary coverage from Tricare Prime (hubs is military). I almost never have any out of pocket costs, whatsoever.

Oops, accidentally deleted the quote designation...

[Sherri297 81]

This thread is so sad and irritating. Our health care system is sooo broken.

For example: Several years ago I had a heart attack, a stent was placed in my heart and after 3 days in cardiac ICU was released. The bills for cardiologist, hospital, everything was $58K. I received top of the line care. Then 9 months later at a different hospital had an angioplasty with another stent placement that was a routine and a scheduled procedure - the bills added up to over $62K. Because of this I was forced to get my WLS done in Mexico. I don't regret it for a second, it saved my life. My bills totaled $5,000 and that included having my gallbladder out also.

I just don't understand how our hospitals get away with what they charge, the discrepancy is disgraceful.

Sorry about the rant, just needed to get that off my chest.

[deana03 9]

When I was in the military I paid $10k in Mexico for my own surgery Jan 7th 2006, it was quite new then. Due to getting pg 3 months post sleeve and in 2011 I had to have Capone surgery hardly moved for a year and took meds, I am now back up to 203 and getting resleeved by the same Doc in Mexico who is an expert by now. They take payments it's $8k and 1k is when you make a surgery date. If you can get the money or a loan you can usually get a date for 1 month later. They pick you up drop you where you need to be and take care of the post meds and hotel, all included. I wish I could get Tri-Care to cover my resleeve 8 years and 6months later but I'm not messing with it. I'm glad some people are finally getting somewhere with Tri-Care. Good luck all!!!

[msfitn2014 248]

My hospital bill was $63000 and i had to pay $1500,.....i paid $1150 the day of surgery and they billed me the rest...i was band to sleeve, had a private room and was there one night! Signed in at 6am wed and released at 1pm Thursday!

[Forsythia 882]

I got two separate EOBs. The hospital charges, then the cost of the sleeve itself. I live in Chicago and went to a hospital in Chicago and the charges were $48,000 for the hospital stuff. The VSG was billed for another $7000 on top of that. My total out of pocket expense was right around $1800 (I had met my deductible but still had part of my out of pocket maximum to meet).

The fascinating thing is to see how much the insurance will just write off. The hospital can charge what it wants but BCBS or Cigna or Aetna are only going to pay a predetermined amount.

[Jersrose43 837]

My hospital charge was just processed

$41,200 for hospital - 28 hours outpatient stay

$29,000 approved

$3000 my portion of cost --- eeeouch

Not bad. Let's see what surgeon bill is when it comes in.

[lifestartsnow4me 81]

I'm a nurse for a major healthcare insurance company and I can tell you that as long as the facility is in network they have contracted rates and won't pay the full amount that is on the EOB.

[boccob81 244]

Bankruptcy is in the future for that .. Are you sure that was. Not a insurance summery and not a bill

[brownsugar73 1]

I received a statement from my doc's office last week and was completely unprepared for what I saw. My insurance was billed for a VSG and Haetal Hernia repair to the tune of 120,000! Holy ****! When I had asked how much the procedure was going to cost previous to the surgery I was told it would be around 25,000 in total and "not to worry" insurance would pick up the tab. When I contacted the billing department I asked how they could justify this sort of charge the associate said that this was a major surgery and the charge was normal. She also went on to say that just because 120,000 was charged it didn't mean my insurance would pay that amount. I replied that according to the statement the insurance paid the whole amount!!!!

Don't get me wrong. I had an awesome experience from beginning to end with my surgeon and his office staff, but was it all worth that much money? I think not. No wonder our insurance premiums are so much. To add insult to injury the docs office also said I had a balance of 2500 to pay out of pocket (after I was told there would be no out of pocket expense). I flat out told them to pack sand. No way am I paying a damn penny. They have had enough.

I appreciate that I am very lucky to have my insurance pay for this procedure. I just cannot believe the gaul of my doctors office to charge SO much! I wasn't even at the facility for 24 hours!

To give some perspective my boss had a tumor in his stomach and had the equivalent of a VSG with a FIVE DAY hospital stay. His bill in total came to 60,000. Can you see why I'm upset?

Actually that's not quite how it works. Insurance companies, doctors offices, hospitals and other providers have set contracted rates.

There are several different ways that contracts are negotiated that includes all of the supplies,the actual cost of the facility,and also your room and board charges. Typically the insurance company will never pay more than what their contract will allow and that's also determined by what was authorized.

Its kinda confusing but I've been in the medical field my whole career, and this is what I do on a daily basis . I'm a glutton for punishment lol

But I do tend to agree that the cost of Healthcare has skyrocketed which then makes the patients responsible for more out of pocket.