4'11 180 lbs... Insurance/self pay combo ?

[auntjanny 289]

I have been in process for 5 of 6 months to get in 6 month nutrition consult requirement. My BC PPO has paid for all tests minus deductibles other than the psych eval.

Despite the severe obesity, I lack diabetes and sleep apnea, and I guess I should be thankful, but, risk insurance denial for gastric sleeve. Has anyone paid for surgery only after a denial? My paperwork will be submitted in August. I have some comorbidities but am not on meds. I will be 53 and would like to live a few decades not sad, hurting with joint pain, and ashamed of my appearance. If I could pay "balance" it seems worth it. If insurance denies, does this mean surgeon must deny?

[Zane's Mom 184]

I knew my insurance would not cover. So my doctors had my insurance cover an EDG and the hiatal hernia repair. Then the wl surgeon comes in after the repair and does the sleeve. For me it was $8200. I was overnight in the hospital and everyone was so amazing and I got a necessary medical fix to help my sleeve perform optimally.

I also had multiple ulcers on my stomach and the sleeve removed most of those!!!

They said that the docs and hospital write off all of the remaining amounts and my cash price was all I paid.

This is the way I decided to go. I'm in dallas Texas.

[Shastasmom 24]

I'm from Canada and there is mo way I will have insurance cover anything. I'm going toTJ Mexico for a sleeve Sept 4th. I have carried this weight give or take for 35 years. As I get older it's harder to lose and harder to live with the extra 50-60 lbs.

so, as of Sept 4th I will be sleeved and hopefully on a losing streak for good! My surgery is $4400.00 plus flights. I'm using travel points so in the end with my husband traveling with me should be around $5000.00.

Not bad since I've paid that plus more in weight loss programs over the past 20 years.

[auntjanny 289]

I wish I had the courage, and the support of my husband, to go to Mexico! It sure is amazing at the difference in cost. I wish you safe journey in travel and weight loss!

[sue_t 7]

My insurance did not cover the surgery so I was a self pay. Although it sucked to have to pay for it, I feel like I have a more vested interest in my health because of it. Insurance dud pay for most of the pre-op tests and they paid for the hernia repair. I think I ended I ended up paying about 11,000 out of pocket.

[kealot 136]

I am going to be a self pay also. The dr diagnosed me with Gerd so my insurance would cover the EGD. Since he found a hiatal hernia my out of pocket portion is only $10,000 because the hospital will be billing for the hernia repair.

[Melodica 64]

The surgeon denying is totally different than insurance denying. The surgeons will probably only deny if you don't get the necessary pre-op testing or if you have some sort of condition that would make surgery dangerous.

I was a self pay and had no issues with the surgeon accepting me for surgery. And my insurance did pay some on the pre-op tests and paid for the EGD/hiatal hernia surgery. I paid $8200 for mine in Texas and insurance paid the hospital and doctors a whopping $16,435 (out of a billed $30,874).

There are many doctors who offer a 'package deal.' The surgery and all associated hospital costs are a flat fee. Some even include the pre-op tests. I know there are some pretty cheap ones in Florida, Louisiana and Texas. Most seem to be right around 10k.

[Zane's Mom 184]

Melodica

Where did you have surgery. I went through dr stowers at mybariatricsolutions.com

The price sounds the same.

My experience was wonderful. I'm in Dallas so they were relatively close.

[Melodica 64]

That's who I used as well. I had to travel from Alabama. I definitely wouldn't recommend such a long car ride the day after surgery! I am pleased with the results though.

Edited July 29, 2014 by Melodica

[getnhealthyintx 281]

I went to the company true results and because I had a hiatal hernia my insurance paid for the hernia operation part and I'm paying about $6800 for the rest of it. I make my monthly payments of $150 a month and I'll be doing that until the 6000 whatever is paid off. I see it as an investment in my future I'm already saving about $75 a month in medicine that I no longer have to take not to mention the wear and tear on my body being 50 pounds lighter.