So disappointed - WWYD?

[nhandy 2]

I'm so disappointed right now. I had my consult appointment scheduled for Friday and today the insurance/billing person called me to discuss my insurance with me and what would be due at the consultation. I was expecting it to be $100 because that's what my co-worker (same employer, insurance and surgeon) had to pay for each of her co-pays since the surgery center is at the hospital. So it came as a huge surprise to me when the last said i would be responsible for $508 on Friday! She said I need to meet my entire deductible for the year that day. I asked why, when I had no assurance I would be approved for surgery would I pay my entire deductible at a consultation and she just said after contacting my insurance, it was necessary. I was so upset and angry and disappointed I just told her to cancel my appt for Friday.

Here's the thing; $500 is a lot of money for me. Do I have it? Yeah, but I wasn't planning on dropping that kind of money until I had some confidence I would be able to get approved through my insurance (Aetna). I don't have the 2 year medical history of my BMI. I have one year medically documented and then I have other means of documenting my weight from 2 years ago from a weight loss blog. But I have no clue if that's something I could even use so I was looking forward to my appt Friday when I could talk to the insurance specialist. I know my Dr would write a letter of necessity and I'm sure I could put together a pretty submittal to Aetna but that may not be enough.

So I'm asking for opinions. What would you do if you were me? The idea of staying fat and unhappy for a whole other year makes me feel so depressed. But if I wait until next year, I will have the two years documented and I know I could get approved with no problem. So do you think I should just hold out another year and try next year? Or roll the dice and pay the $500 and take a chance that I may be able to get it done this year?

[pinksjo1 137]

Check with Aetna. Find out what hospitals they will cover and call another hospital. That seems way too much for a consultation. Mine was covered except for the $20 co-pay. Good luck!

[Bro Rob 43]

• I would call them back and ask them what they are charging for the consultation....find out what procedure codes they are/will be billing. Then call your insurance company and find out what they will allow / pay for those specific procedures....If this is strictly a consult...no labs, xrays, etc...depending on your policy...you should only be responsible for the applicable office visit copay...If you're plan is a PPO type plan that requires you use a network provider for the best benefit, be sure to check with Aetna to confirm if your doctor is participating - CALL Aetna....do not base the provider participation status on an online or printed directory as these are often outdated....and DOCUMENT EVERYTHING...NAMES, DATES, DEPT, PHONE #...in case you end up having to fight with them later on....As for the situation of having the same employer and same insurance...it is very likely you and your co worker signed up for two different policy...My employer uses United Healthcare, but employees have six or seven different policies to choose from.... Please feel free to message me if you have any additional questions. I have been a health insurance claims examiner for more than twenty years, and will be glad to assist in any way I can. Best of Luck!!

[nhandy 2]

Thanks all. I did call my insurance company for clarification and they said since they are billing as a hospital, they do collect the entire deductible upfront but then after the insurance company received the explanation of benefits, they will let the hospital/dr office know how much to refund me. So if it never goes past the consultation, I'll get the bulk of that money back. I don't love the idea of doing it, but now that I know they aren't going to keep the whole thing, I may be ok with it.