Aetna and $15k bariatric cap

[TN_Gal 15]

Help!! I have my first consultation tomorrow at Vanderbilt in Nashville for Gastric sleeve. I just found out TODAY that I have a $15k cap for all bariatric surgeries. I'm so confused what this will mean for me. I've read several posts about some people who had doctors that negotiated the price down and didn't have to pay anything out of pocket and others who ended up with a $60k bill because of the cap on their insurance.

Any insight or advice out there? I would rather pay out of pocket than end up owing a ton of money due to a cap.

Thanks!

[Elode 8,093]

@ Your surgeon should be able to tell you what he/she charges for the surgery. My insurance covered all mine but my surgeons financial lady Gave me a sheet with the breakdown of what he charged. Surly they can give you so idea.

[Elode 8,093]

*some

[mrsmith901 18]

I'm in Memphis and my surgeon's fee is only $6000 for the sleeve. Hopefully it's not much more at your surgeon's office!

[ai2 0]

Hello! I am new to this site and was looking for this very topic. I have a $15K cap, max of 80% payout. $60K is what I was told would be total cost with ins. and was then given a cash only option of $15K. Can you say devastated! After months of investigating, I decided to with Dr. Ortiz @ OCC in Tijuana MX. I was able to take advantage of a business trip there and tour the facilities and meet with Dr/Nutritionist. I am now scheduled for Feb. 13th...wish me luck.

[TN_Gal 15]

@@ai2

I met with an insurance specialists at vanderbilt and we talked for about 45 minutes regarding the cap. She said that the surgeons will write most of the fees off and showed me the bill of another person that had the same insurance as me. Her total out of pocket came out to be around $6000 after all the write offs. You might consider talking to the insurance person at the office you were going to use in the states.

[ai2 0]

I tried that route, even asked if I could pay the out of pocket and then file on the back end. I was told that wasn't possible. I am willing to pay up to $8000 considering that's would be my cost plus airfare for 2 to TIJ. And clearly I don't mind traveling so if you have a better way I am ALL EARS, and appreciative of the help!!!