2nd Surgeon Needed but Not Covered by Insurance?

[Tandiyah 0]

So I went for a consult yesterday at a large weight loss place where I live. They said my entire surgery was covered by my insurance, except for the second surgeon they required to oversee and help out with the actual surgery. The cost was $3500 for this supposedly necessary second surgeon. When I pressed for more information on why he was needed and why it wasn't covered the woman got a little flustered and went into a whole "it's hard to find doctors who aren't "out of network" thing.

Is this just a scam by this company to make more money or is it standard? Has anyone else run into this?

[Sajijoma 1,324]

I've never heard of needing another surgeon. When I had my surgery, there was a surgical assistant that was used who was not covered and that cost me $500, but I've never heard of needing a second surgeon. In fact, some places are doing the sleeve via robot now, so needing 2 surgeons does seem a surprise. Are you going to a Bariatric center of excellence? If not, you might want to consider transferring to one.

[Larry Stuto 6]

Had sleeve done at kaiser. Insurance covered 100%. Never heard of an Xtra surgeon fee?? $$$

[2goldengirl 2,076]

I've authorized dozens of bariatric procedures and an assistant surgeon has never been requested. Whether or not an assistant is covered is based on standarized criteria, meaning that it's either necessary for everyone or nobody, depending on the surgical code requested.

I'd definitely do more checking, call around different practices and ask whether their surgeon's require an assistant or no.

[scoots 16]

My insurance is covering the whole procedure except for a $150 hospital copay for admissions. I have never heard of anything like that. Is the surgery taking place at a reputable hospital?

[rhya2k 31]

2goldengirl

Have you heard of insurance covering a revision from lap band to sleeve due to too many issues even with bmi being 32 not 35

[atlmag 77]

I actually had sleeve (self pay) and Hernia (insurance covered). I was a little surprised when my surgeon's PA put in claim for surgery assistance, my insurance paid the $800 claim as in-network and paid the PA $77.00 as this was the in-network negotiated rate. With that I think the $3500. is a scam . how much assistance do they really need for a 45 minute surgery.

Edited January 23, 2016 by atlmag