Upfront cost - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

chandra_d_gay · 03-23-2009, 08:30 AM

i have a question.... I have no deductiable, i am approved, and i have a 2000.00 max out of pocket per year.... What cost are they going to make me pay before surgery?

hexx2003 · 03-23-2009, 08:36 AM

depends on your insurance. Also, your practice may charge a fee that isnt associated with insurance. that has to be paid prior to surgery.

I met my deductible, had max 1000 Out of pocket, and paid like 76 bucks total for the surgery. after the fact, just the 750 for the program fee prior.

SueRN · 03-24-2009, 11:41 AM

Actually, it depends on the surgeon/hospital. Insurance doesn't ask for any upfront costs because you don't pay them. They pay out based on the benfits of your policy. Some hospitals will require you pay your deductible upfront. Some will estimate your out of pocket cost based on the contract they have with your insurance and ask for that upfront. Some don't ask for anything upfront. Some programs have fees associated that are for administrative costs. I had a 200.00 program fee. Then I also had to pay upfront for the psycologist 500.00. They gave us a claim form to submit because for most insurances, psycologists are out of network. They will have contracts with MD-psychiatrists, but not PhD-psychologists. So do, but most don't. Some have even higher program fees. It all depends. You need to check this out with your surgeon's office and the hospital billing office where you will have the procedure. The surgeon will only bill for his fee and has nothing or no say with the hospital costs. sue

justroni · 03-24-2009, 12:16 PM

Hi, I already know exactly what I have to pay. My surgeons office told me on the day I signed up with them the cost of everything, and what my insurance would be paying. I had to pay a $1600.00 dollar fee which covers my doctor appointments pre op and 1year post op, 6 month diet history,psych evals, nutrition classes, pre-op support groups which meets 1 time a week, post op support groups which meets 1time a week.

My insurance will cover the whole hospital bill except for $800. and $360. on the surgeons fee. I have to have all of this paid before my 6 month diet history is done.

They deal with the insurance company I just had to get a letter from my family doctor, and 2 year records showing my weight. I don't contact the insurance company at all. I have CIGNA insurance.

chandra_d_gay · 03-25-2009, 06:59 AM

Thank you all so much for your input. I really appreciate. it

Cabbie · 03-25-2009, 10:00 PM

I have an HMO that requires a $500 co-pay whenever I am admitted as an in-patient. When I was pre-admitted to the hospital a few days before my scheduled surgery date, the woman admitting me asked that I pay the $500 co-pay then and there. It's a good thing they had an ATM machine in the hospital lobby.

RebeccaNV · 03-26-2009, 11:57 AM

I have a max out of pocket of $3,000 but the surgeon wants $1,500 before surgery, anesthesia wants $400 and the hospital wants $2000 before hand. I called my insurance (Tricare) and and the rep said that I just had to pay what they wanted and hope to get reimbursed. My cost share is 80/20.

fyremanjef · 03-26-2009, 12:48 PM

I got my bill from the hospital it was for $9000 and change. Paid in full by insurance. I did have to pay out of pocket for the surgeons co-pay, $125 for the psych eval (cash only) and Insurance is reimbursing $10 woopie. and then $150 for the "nutritional counseling" which the NUT read the booklet to me. that claim was denied.

I have a friend who is looking to get this done and one of the surgeons on MD's eastern shore wanted $1500 that included a gym membership and Nut counseling etc.

Sometimes i thing parts of this are a scam.

deputymauldin · 04-06-2009, 11:16 AM

At my first visit with the surgeon's office they gave me an estimate of $1500. Everything else is covered with the exception of my my $20 copay. Not bad I guess. The psych is covered if I pick one that is in-network and I did. It was easier than paying $250.

joy1968 · 04-10-2009, 12:34 AM

Quote:

Originally Posted by fyremanjef

I have a friend who is looking to get this done and one of the surgeons on MD's eastern shore wanted $1500 that included a gym membership and Nut counseling etc.

Sometimes i thing parts of this are a scam.

Jeff, I don't understand the gym membership part? Why would the be part of the physician's fees?

So far I've had to pay for the surgeon consult fee co-pay which was $15. The NUT co-pay which was $25. I haven't gotten a statement from my insurance company so I don't if anything was denied. The psych eval I did as self pay and it was $75.

I previously called my insurance company to see how much would this surgery cost me and the customer service rep said the hospital stay would be 100% covered as long as it was at a HCA facility.... it is. The doctor's fee would be covered 80/20%.... I'd have to pay 20%. I'm guessing that would be the same deal for the anesthetist.... which I'm thinking will be $100-250. I'm guessing that prior to the surgery I'll have to pay the surgeon my deductible $250 then hopefully he'll let me make payments. If he doesn't then I'll have to dip into my savings.