x-posted - So disappointed - WWYD?

[nhandy 2]

Hi all, I am cross posting this here as well as in insurance to get as many opinions as possible. Hope you don't mind.

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?

[Carlotta1 401]

A consultant appt. should not cost $500?. .. I was charged nothing till right before surgery. I paid what was left of my stop -loss amount for year 2013 a couple of days before surgery.

If I were u I would not wait for another year. I documented my weight loss history and had my gyno subunit my weight for the last 5 years I had annual well woman physical.. Maybe your family dr has a record of your weight ..

Also talk to your insurance and see what qualifications u have to meet to have the surgery. Evidently with this doc u will to pay for a consult no matter when u start this process. Your friend that paid only 100$ may have used up some of deductible and that is why she paid less than what is required by you.

[Madam Reverie 2,958]

I just paid the equivalent amount of $1700 for pursuing a job (travel/hotels etc) I knew I had little chance of getting.

I still rolled the dice though.

Your friend has the same insurance.. Worked out for them. This is the entire deductable for one year - it's $408 more. In the greater scheme of things, its not a deal-breaker. Its just frustrating and more than a bit inconvenient.

No guts - no glory - that's what I say.

[1Day1Life4Now 882]

i had to pay my $500 up front before they would even send anything over for insurance approval. I thought it was odd but I paid it and everything else went smoothly. Sometimes the doctor's office wants to know you are serious about getting this surgery and if you are serious enough to put down the money up front, they know you probably won't back out after they have jumped through all the hoops , doing all of that paper work and have you a surgery date. I don't think they keep the money if you don't have surgery. Either way, you have to think about how serious you are in having the surgery and what are you willing to do to make it happen? Also, any doctors you have been to in the last two years have records of what you weighed. They can submit those records as proof of your weight history. Good luck to you and hope you can make the decision that is right for you.

Janet

[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.

[LindafromFlorida 1,542]

My husband and I paid total of $600 non refundable. Backing out was not an option, no matter what, with insurance covering this surgery. I agree with Madam, go for it. Small price to pay for a new you. Knowing what I know and seeing my new me in 2 months since surgery, it was so worth it!