Self Pay vs Insurance Timeline/process

[Bozzj 0]

Hi All,

I have BCBS, but I may end up self-paying (not sure yet) for a bunch of reasons. My question is what is the difference in regards to the process/timeline if you're self-pay vs insurance?

Long story short...i really don't want to wait a long time to get this and today I found out that my company-not insurance-makes the decision to pay or not. I don't want them to know my business...so i may opt to self-pay. Not decided. Would that speed up the process? Do self-payers have to go through the same steps?

Thanks

[georgia girl 35]

It really depends on the insurance and the surgeon. I have BCBS Federal Employee Program insurance and it only took about a month from my first visit (they sent the claim to the insurance company right after my 1st visit) to surgery day. I was very lucky because some insurance companys require a monitored diet for months.

Have you met with a surgeon yet? If the surgeon doesn't require a bunch of pre-op stuff, you can probably get the surgery pretty quick going self-pay.

[linzchavez 0]

I was self-pay. My company didn't cover this, so that was my only option--but, like you, i did not want to wait for a 6 month monitored diet period. From the time of my first appt. with Dr. K I had surgery within a month.

[allykat 1]

I initially started checking into surgery using my insurance. It ended up being an excluded procedure, but the time involved to go that route would have been about 6 weeks. The surgeon who was included in my network required nutritionist visits and a psych eval, and that was where the time came in, actually getting in for those visits and giving the surgeon time to get the reports back. Then of course you had to factor in the time that your insurance company would have in reviewing your case. Although my insurance wouldn't necessarily require the psych and nutritionist visits (long story but I was at first told yes it was covered only to learn later it was excluded), this particular surgeon required them anyway.

After deciding self-pay was my only option, I contacted the surgeon's office I initially wanted to use. From there, it was mainly a few emails with the staff to find out the process and make my appointment. From appointment to surgery date is two weeks. Once I had my financing in place, I had my first appointment two days later. Funnily enough, we actually scheduled my surgery date first and then worked back two weeks for my initial appointment. I went to that appointment and did all the preop stuff at the hospital that same day.

While it has certainly moved quicker being self-pay, I would have waited it out to have insurance cover it. The only thing that might sway me would be that I do get to use the surgeon I want (and he is more experienced) than if I'd had to use my insurance. Since it was excluded, it was a mute point anyway.

[luluc 6]

I had a difficult time w/BCBSTX for both husband and self - We got annoyed when in month 4 they deviated from the initial requirements (I was never going to be approved: BMI 37, no Comorbids, but DH had a Great Chance: BMI 43 + 3 Comorbidities...he was eventually denied, but we had already gone thru w/the surgery).

The minute I called our surgeons office and said we would be Self Pay, we had a date for surgery 2wks later. My Opinion, the office stepped up Fast & was extremely accomodating in order to get a $30k Check in hand. Love my Dr, but I think they might just speed things up a bit more for Self Pays - again that's my experience only.

Good Luck to Ya~

[Bozzj 0]

thanks for sharing your experiences. I'll probably end up going the self-pay route. My hubby and I spoke yesterday and he is not in favor of my company knowing my business. Meaning, the company I work for pays the claims, not the insurance provider. This means if I go to the doctor- i pay whatever my share is and the company, not bcbs, pays the rest (this is new as of this year). SO, with this kind of surgery sr. mgmt would most likely be alerted that an employee (no name mentioned) from X department requests X. Then they approve it or not. I'm the only bigger person in my department. This is my understanding of how it works and i don't want people knowing my business.

That being said, i still have to go to my consult on Monday and discuss payment options. They did say they have financing options (or we might go the ccard route and then just pay it off later this year). This, of course, is for the outpatient facility and not hackensack hospital (the hospital is about 30k).

I want to make sure that the price the doc gave in the seminar, 15k (with first year of fills) covers everything and there's no hidden fees or whatever.

[Angie4b1g 1]

I would have gladly had it take a little longer and saved my $13k. But my insurance didn't cover it. It took about a month once I started the process until surgery date, but only because the hospital required to be paid 3 weeks prior to the date. So, one I paid, we booked it for 3 weeks from that day.