Insurance vs Self Pay

[kcaves 3]

I am looking at gastric bypass and have a dilemma. The Dr. office says do self pay, it will be cheaper. The insurance company says no use your insurance since we have allowable rates the Dr. and hospital must follow. My insurance company pays 50% up to $10K. Here is the problem.....I can't get a straight answer as to what my cost would be using insurance. The Dr. says they can do "everything" as self pay for $23,000. They had someone from the hospital quote me using the "estimated allowable" which is $36K is I use my insurance. How could it be more expensive to use insurance??? Ready to pull out my hair!!!

[jtickle 295]

If I understood correctly at my surgeons office, self pay is actually a discounted rate. Of course, they are going to charge the insurance more that is how they make most of their money. I have seen several people on this forum who have had well over 50 or 60,000 billed to their insurance.

[Sue Magoo 71]

Hello:

One other thing to find out is if you don't use insurance will any post-op complications related to the surgery be covered. The answer to that might help you with your decision.

Please share here when you do get the final answer so that we can all learn from your experience.

Take care.

Sue

[jodie1961 77]

I am going thru Anthem bc/bs...and I noticed that my surgeons office gave me my co-pay and deductible, after they showed almost a $5000 insurance write off. They agree to do it for the lessor amount covered by insurance. I thought to myself, "Oh wow, I would hate to be self pay, they charge them more", but who knows, you cannot get a straight answer when it comes to cost in the medical field. Hang in there.

[MthrEffinPrncss1126 11]

<p>I am looking at gastric bypass and have a dilemma. The Dr. office says do self pay, it will be cheaper. The insurance company says no use your insurance since we have allowable rates the Dr. and hospital must follow. My insurance company pays 50% up to $10K. Here is the problem.....I can't get a straight answer as to what my cost would be using insurance. The Dr. says they can do "everything" as self pay for $23,000. They had someone from the hospital quote me using the "estimated allowable" which is $36K is I use my insurance. How could it be more expensive to use insurance??? Ready to pull out my hair!!!</p>

Have you called your insurance company? I work for bc/bs and I know that there is a limit of 10k but only on travel expenses when using a blue distinction center. Also if the dr is par with your insurance then their contracted amt is usually a lot lower then 23000$. If you could call your ins and get your benefit breakdown I could explain it a little better to you. Believe me I know it could be crazy!

[MthrEffinPrncss1126 11]

<p>I am going thru Anthem bc/bs...and I noticed that my surgeons office gave me my co-pay and deductible, after they showed almost a $5000 insurance write off. They agree to do it for the lessor amount covered by insurance. I thought to myself, "Oh wow, I would hate to be self pay, they charge them more", but who knows, you cannot get a straight answer when it comes to cost in the medical field. Hang in there.</p>

I am also using anthem bc/bs. My total cost should be somewhere around $2500...way better then the initial cost of surgery. When are you scheduled for?

[kcaves 3]

I have called my insurance company and was only able to give them the code given to me by the Dr. The rep for the insurance company said the allowed amount for the code was $1185.00. My question was is this code for the Dr. fees or the procedure as billed by the hospital. They could not give me an answer. The rep told me to have the Dr. and the hospital request a predetermination. I did this and they both told me "we don't do that until right before your surgery." REALLY? They do these surgeries all the time so they know what to give me.

I am meeting with a different physician on Monday and I'm anxious to see what answers they give me. I just get the sneaky feeling they are trying to "hood wink" me into self pay because they will make more money.

Question for you Mthreffinprncss1126...in your experience do you think is is possible to self pay and then turn all bills over to the insurance company and ask them to reimburse (pay me) what amounts they allow?

[MthrEffinPrncss1126 11]

I have seen some people self pay for out of network physicians and then turn claims over to the insurance but you have to make sure it is still a covered benefit and follow the requirements