Insurance Cost

[dfwtxfemme 3]

the only problem is is the whole 19000 is paid to the doctor and he pays the hospital but they tell you the breakdown is 11,000 for the hospital 1200 anesthologist and 6500 to the surgeon.... again it's no big deal I mean its cost for cash patient I just know that it's a lot more than what the insurance companies contracted rates are for.... like the previous poster said her surgeon contract rate was 1200 dollars and I have to pay 6500 to him that the 500 percent markup.... it doesn't matter I was just curious as to what the markup was and clearly now I know.... I'm in the hospital for kidney and other things all the time I know how insurance work I just have a weight loss surgery exclusion which makes me a cash patient for it.... I know I my kidney surgery the anesthesiologist billed my insurance 1500 dollars and ins paid him him 300.... again up 500 percent markup but it doesn't matter I mean if I what the surgery I will pay 19,000.... seems all is said and done insurance get away with around 10 to 11K.... which is only twice as much but that's still a significant difference... I wish cash patients could just pay whatever it is the insurance companies pay

[makemyownluck 785]

insurance companies get discounts because they are basically guaranteeing the hospital business from the people they insure. typically, insurance companies pay anywhere from 50-80% less than what is billed.

Considering this is an elective procedure, I would *think* hospitals would be less likely to offer a discount to a self-paying person. Where as, if you had surgery because your appendix burst or something, and you were in a hardship, then they'd be more likely to help you.

Bottom line - get insurance.

[dfwtxfemme 3]

that kind of sounds ignorant. I have insurance I own my own company actually. the money is not an issue, it's the principle. most people do not have weight loss surgery covered unless they work for a company with over 500 employees. and no private insurance plan covers it. to provide some more education if you have a private independent insurance plan you also do not get maternity coverage, the only way to get maternity coverage and prenatal care covered is also through a company with large employee base. it's kind of ridiculous when you consider that I pay 420 dollars a month for insurance, but is just how rules are. maternity coverage is the most frustrating. it doesn't matter what insurance company I pick either, it is statewide it might be a national thing but it's definitely a statewide thing in Texas. My babies will b cash babies also

[makemyownluck 785]

There's no need to insult a dissenting opinion, dfw. I'm not ignorant, on this topic anyway. Private insurances do pay for WLS surgery. I work in individual health plans - most do cover it.I'm talking MAJOR carriers - BCBS, Aetna, Anthem, Cigna, Kaiser - I can't (and won't) speak for smaller companies that aren't going to pay for much anyway. As far as small group coverage, they pay for it too, if you have a plan that includes it. Same for maternity. You have to purchase that coverage in addition to basic coverage. Maternity costs a lot of money! To a self-pay or to an insurance company - but you think they should include it for free?? How can they afford to? $420 a months is not much compared to the millions insurance companies pay out.

I realize that many people won't take my side on this, because it's the touchy subject of health care. No business would survive if they just covered every surgery for every person who ever wanted any type of surgery done - people self-paying can't afford to just do whatever they want - but assume that because they are insured they are entitled to it. If you get in a car accident with a Toyota, are you supposed to get paid to buy a new Mercedes? Not unless you get some insurance that will pay 3x the worth of your car (which, btw doesn't exist because it couldn't).

We are not "entitled" to WLS. Just like we're not "entitled" to own homes, cars, vacation in Europe - whatever else in your life that you'd prefer to have. I don't think people shouldn't have a right to basic care - but as a taxpayer, I will be the one responsible to pay for everyone to have insurance, and that doesn't seem fair to me! Especially if they want to go out and get expensive elective surgeries, or expensive infertility treatment or other types of medical care that are not a requirement for life. I feel like I "need" to have WLS - but that doesn't mean it's not still an entirely elective procedure to have.

[dfwtxfemme 3]

okay we can just end this. in Texas you cannot pay for it in addition. I am with Blue Cross Blue Shield in Texas it doesn't matter who you go with there is no maternity coverage and u cannot add on if you have a private plan. I'm not looking for a handout I'm not looking to have anything finance I have the money for it I was curious as to how much more it cost a private cash person than does insurance that is all. i know doctors and hospitals make more money off of me, was just curious as to how much. do I think insurance rules r fair? absolutely not but I can't change them either. a person can work minimum wage at large company and have the whole surgery provided for and they just pay the deductible. private plans have many exclusions again I don't know if the individual state thingor what but at least in Texas you cannot add on. and yes this is elective and I get I don't care about the money it's just the principle I wanted to know how much more i pay than what insurance company paid. all they're doing is taking advantage of someone that has money. but it on another topic which isn't for this forum any female should have maternity coverage with insurance. but I do not yet my own patients do because they live of the government or are indigent can have as many kids as they want and we pay as the taxpayers I have a kid I have insurance and I have to pay cash. thats American welfare system for you there. this just start out as a simple question how much more the cash person pay than insurance company paid it's about 10 grand more that's all I wanted to know it doesn't matter

[dfwtxfemme 3]

and besides the end of the day with Obama in office the higher tax people will continue to pay for the whole lower bracket healthcare, the immigrants are in the country they use our schools and our hospitals for free, everybody is on food stamps 5 or 6 kids on welfare they still get pregnant and have completely free healthcare, prenatal and maternity and wic. I wasn't talking anything about getting surgery paid for having somebody else cover it, and no where did I say it should be covered in my policy, I am aware how insurance works and what is covered in what is not in my policy and what is available to me and not in the state of tx. and I wouldnt care if they charge me more to include maternity the point is it should be available to me and it is not and I can't claim that I'm indigent either

[makemyownluck 785]

okay we can just end this.

LOVE how you start a post that we can end it - then spend the next TWO posts bringing up things that aren't really relevant to the discussion, and dismiss everything I say by bringing up a different point. Very creative debating skills you have.

I agree that this isn't necessarily the forum to discuss these matters. Good luck to you. I'm glad you have the money to pay for the surgery you want. I wish you well.

[rabrijumo 140]

As a nurse I find this discussion interesting oh maybe I should also say a mom, and a democrat. I believe we do not NEED healthCARE reform in this country we need health INSURANCE reform. As the original poster stated insurance companies do not allow smaller businesses to provide full coverage options ie maternity and or WLS. Small biz also has to pay higher premiums. Personally I think Obamacare tried to close loopholes in insurance companies and succeeded to a degree. Kids who turn 18 and either are in school or trying to enter the workforce and are working for companies that can not or will not provide insurance to their workers can be covered by their parents ins until age 26. I am amazed at the people who HATE Obamacare and misrepresent it. Wtf is wrong with covering as many people as possible. Insurance companies are not just gouging the American people they are actively ripping off millions to protect their inflated salaries. I have been denied coverage for procedures that are most definatly covered but they roll the dice and deny it just to see if the patients will pay up not knowing that the service is covered. For example I got orthotics ( shoe inserts) my insurance paid a coworker had to pay 400 bucks we have the same policy why? Another example was my son injuried his finger and I took him to the emergency room because the finger was becoming strangulated. They took care of it. the ins said it wasn't an emergency and I should have waited 2 days and took him to the drs office. I had to write a letter defending my desicion which I did and they paid. if I hadnt been proactive I would have paid that bill for a covered service.

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[tmorgan 87]

Wow

[cookier224 238]

I only paid $25 co pay and $600 program fee. I have military Tri-Care Prime.