Insurance Reimbursement for the Band

[reeciecup 0]

Hello,

It is always great to hear of approvals for the LAP-BAND. I hope that insurances are turning the corner and realizing the long-term benefit of paying for the band and saving on costs in the future regarding obesity related problems...You would think that it's a no-brainer to the insurance companies, but I think a lot of them are in the mindset of save the money we would have to pay out on claims now and worry about the consequences later...Hopefully, with the approvals I have seen on this site, that is changing...

I was wondering just how much insurances are actually paying for the band...for the facility charges, as well as the anesthesia charges and the surgeon's charge. I wonder if we could all help to compile some information to see what it really costs the insurance companies..we could actually "band" together and make a difference for those who have not been fortunate enough to have been approved...

So, if you are interested, please list the state you are from, your insurance company, and the amount paid from you explanation of benefits for the facility, the anesthesia, and the surgeon...Please don't list your name---I think it will be very interesting to see what the "bottom line" is that the band actually costs the insurance companies!

Thanks!

[Shalee04 7]

I have United Healthcare HRA Plus, thru GAP Inc.

This info is directly from the EOB my insurance company sent me, At the moment they are still pending payments. My surgeon bills out of network, I had to pay him up front $3500 two weeks before surgery.

Hospital. $31.275.31

Surgeon fee, $6125.00

Surgeon Assitant, $2200

Anasteoliogest fee, $1800.

Physc fee, $200.00

Misc Lab fees I have paid. 1200.

and I paid $300.00 to the hospital, they said that would be my co-pay of the hospital fee, BUT I know I am supposed to pay 20% of the hospital, and well 300 doesn't add up..

I will post again when I get the EOB wshowing just exactly WHAT and HOW much the insurance covered and How much I will have to be paying..... (Hopefully not too much)

[Wheetsin 714]

You would think that it's a no-brainer to the insurance companies, but I think a lot of them are in the mindset of save the money we would have to pay out on claims now and worry about the consequences later..

Insurance providers are businesses and businesses aren't around long if they don't make money. Most people stay with a provider fewer than 4 years. 4 years isn't enough longevity to see significant ROI for insurance companies. I used to work for an insurance company and my husband's work is affiliated with a separate one, and both see the same thing -- in any procedure where it requires some time to make up the cost (e.g. decline in medications or office visits), insurance companies just aren't seeing the "loyalty" of people sticking around long enough for them to see the savings. That's why more and more are exclusing procedures such as WLS. It's not really about making money so much as not losing money. Insurance companies make their money on investments, not premiums.

Quoting myself from a previous post:

Total charge = $29,076.25

Network discount = $27,402.25

Allowed amount = $1674.00

Paid by plan = 100%/$1674.00

Patient copay = $0.00

Patient responsibility = $0.00

[Shalee04 7]

Insurance providers are businesses and businesses aren't around long if they don't make money. Most people stay with a provider fewer than 4 years. 4 years isn't enough longevity to see significant ROI for insurance companies. I used to work for an insurance company and my husband's work is affiliated with a separate one, and both see the same thing -- in any procedure where it requires some time to make up the cost (e.g. decline in medications or office visits), insurance companies just aren't seeing the "loyalty" of people sticking around long enough for them to see the savings. That's why more and more are exclusing procedures such as WLS. It's not really about making money so much as not losing money. Insurance companies make their money on investments, not premiums.

Quoting myself from a previous post:

Total charge = $29,076.25

Network discount = $27,402.25

Allowed amount = $1674.00

Paid by plan = 100%/$1674.00

Patient copay = $0.00

Patient responsibility = $0.00

$1674.00 WOW that sure isn't much for them to make...

The breakdown of my hospital bill I recived showed just the charge for the band is $6390.00.:faint: I was like wow. I am curios to see what the total for everything will be after network discount for my UHC HRA Plus.

[Wheetsin 714]

$1674.00 WOW that sure isn't much for them to make...

Nope, that's where volume comes in.