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Out of pocket expense

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I was wondering what most people paid out of pocket for the gastric sleeve after reaching their deductible?

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This depends on how much Out of Pocket you have left.   You have to meed deductible and out of pocket before insurance pays at 100%.

I have a 3500 out of pocket so that is as much as I will pay in the entire year.

Edited by Jolls

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As Jolls said, it depends on you deductible.  I got my surgery early in the year so had all of mine to pay which ended up being around 3 grand all said and done.

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Mine was only $1000

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I have a $3500 cap on what I pay out of pocket each year, so that's what I expected to pay.  One little tidbit of helpful information though...I had surgery in September.  Bill came in October.  I called to make "payment arrangements" on the $2,500 or so that was left to pay after my out of pocket max, and because they were anxious to "close out the books" and get full payment before the end of the year, if I could pay 50% of what I owed (around $1,250) and not make payment arrangements, they wrote off the other 50%.

So, I basically saved myself $1,250, simply because of the time of the year. I gladly paid the $1,250!! :)

Edited by jilliebeanmn

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I have Medicare and they covered 80% I paid 20% which was $10,000 . I didn't have regular insurance it give you a very different   veiw on following your plan . I hope you get to paid a lot less than I did !

 

                     Mike

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it also depends on the allowed amount for the provider.  you will get separate bills for the surgeon, the facility and possibly the anesthesiologist.  all of them will have different allowed amounts.  you may be able to find out what the allowed amount is for the surgeon, probably not for the anesthesiologist and almost certainly not for the facility.  these amounts are determined by contract and contracts are private.  anesthesia is a complex formula that uses the type and time. 

this is assuming you are using all preferred providers for your insurance company.  many anesthesiologists are not preferred with anybody.  in California blue shield covers non-preferred anesthesiologists as if preferred if the facility is preferred since you don't have any control over that.  blue cross does not.  you are basically s.o.l on that.  don't know about other insurance companies. 

call customer service and find out where you stand with your deductible and out-of-pocket max.  then you can try calling your surgeon and facility to try and find out what you will have to pay them. 

this is all for ppo plans.  if you have an hmo you will only have to pay your copay for the facility and surgeon. 

hth.

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it also depends on the allowed amount for the provider.  you will get separate bills for the surgeon, the facility and possibly the anesthesiologist.  all of them will have different allowed amounts.  you may be able to find out what the allowed amount is for the surgeon, probably not for the anesthesiologist and almost certainly not for the facility.  these amounts are determined by contract and contracts are private.  anesthesia is a complex formula that uses the type and time. 

this is assuming you are using all preferred providers for your insurance company.  many anesthesiologists are not preferred with anybody.  in California blue shield covers non-preferred anesthesiologists as if preferred if the facility is preferred since you don't have any control over that.  blue cross does not.  you are basically s.o.l on that.  don't know about other insurance companies. 

call customer service and find out where you stand with your deductible and out-of-pocket max.  then you can try calling your surgeon and facility to try and find out what you will have to pay them. 

this is all for ppo plans.  if you have an hmo you will only have to pay your copay for the facility and surgeon. 

hth.

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I know you didn't ask but I was self-pay.  My bio was below threshold of 35 with my comorbidities and I paid just under 14000.  

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All depends on your insurance coverage.  My max out of pocket was $2000.

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Wow!  Y'all got by cheap!  I paid $6500 out of pocket max. 

Now I need to come up with a list of everything else I might like to get done this year.  This even covers my office visits.

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I love Kaiser. $250 for the surgery, the night in the hospital, everything. Maybe another $125 in copays for different appointments, plus about $400 in gas to go to the options classes and the appointments. Paid for it all, even the gas, out of my health savings account, which made it all pretax dollars, which saved me about 20%.

I love Kaiser. 

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For deductible and out of pocket $1900 for surgery and appointments this year related to surgery. 

Cheap compared to what it's going to cost me to get a whole new wardrobe.:o

 

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Thank goodness I've met my deductible.  I tried looking at the Aetna website and they have an estimator but wls isn't one of the possible items to estimate.  I'll just call and hopefully find out.  My surgeon and hospital are both in network.  I have to go to St. Petersburg but that's not too bad.  I've seen where some have to travel 5 hrs.  

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For deductible and out of pocket $1900 for surgery and appointments this year related to surgery. 

Cheap compared to what it's going to cost me to get a whole new wardrobe.:o

 

The smaller the clothes the cheaper the price.  The price you pay for a blouse at Lane Bryant is so much!  You can always find cute clothes on clearance.  

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The smaller the clothes the cheaper the price.  The price you pay for a blouse at Lane Bryant is so much!  You can always find cute clothes on clearance.  

True the selections are much better but replacing everything is really tough.  It's a good problem to have!:rolleyes:

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I have a 3750 deductible and 6000 max OOP.  But my insurance doesn't cover WLS at all, so I went to Mexico.  Airfare and hotel for me and my sister, preop labs and cardiac work up, surgery, hospital and all postop meds came to about $7500.  That money was earmarked for a down payment on a new truck but instead I'm 100 pounds lighter and still drive my 16 year old rust bucket. And I continue to pay out of pocket because my insurance won't cover the followup bloodwork as they deem it "unnecessary"

Worth every penny.

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I had an out of pocket maximum of $2000, most of which I had paid through the months of appointments and tests required for approval.  My bill after surgery was less than $200. 

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$1100 deductible. i work for the same company that owns my hospital, so - employee discount. insurance paid 90%, i took care of the other 10%. still working on paying it, though. :X

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Everyone's insurance is different.  For me I had to pay for each doc/nut visit a $20 copay and the copay for the actual surgery/hospital stay was $200.  I was super lucky with my insurance!!!  

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I had no idea that some people had to pay soo much out of pocket.  I think I was the same as Moody.  I had to pay for my 3 NUT visits, my Psych Eval. and insurance didn't cover 3 techs in the surgical room, only 2, so I had to pay out of pocket for the additional tech.  35x3 + 185 + 250.  And of course all of my vitamins and proteins that were required purchased 2 weeks prior and wasn't covered.  I have Tricare, no deductibles or co-pays, I forgot that other insurances require deductibles. 

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I had no idea that some people had to pay soo much out of pocket.  I think I was the same as Moody.  I had to pay for my 3 NUT visits, my Psych Eval. and insurance didn't cover 3 techs in the surgical room, only 2, so I had to pay out of pocket for the additional tech.  35x3 + 185 + 250.  And of course all of my vitamins and proteins that were required purchased 2 weeks prior and wasn't covered.  I have Tricare, no deductibles or co-pays, I forgot that other insurances require deductibles. 

  

I used to have a decent policy....$30 copays and $1500 deductible.  Then along came Obamacare and my insurance coverage went to *&^%.  I'm one of the many that got screwed because I make too much to qualify for assistance but not enough to be able to afford the outrageously priced policies.  The only policy I can afford now has no copays and over doubles my previous deductible.  At this point I have to fork out over $8000 of my own money in premiums and deductible before insurance kicks in a single penny.  And that doesn't even count the stuff that doesn't get counted towards my deductible because they don't consider it "necessary".   Over the last two years I've had to spend over 20% of my gross annual income for medical expenses. For me there's absolutely nothing "affordable" about the Affordable Care Act.

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I paid in total $6000 out of pocket.  This is on top of the health insurance fees I had to pay for a year.  If I wanted to pay totally out of pocket I would of been up for at least $20,000, if everything went well.

A bit of a moot point though considering how different private health insurance and the the health system works in Australia compared to the USA

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Paying out of pocket here is around $28,000.  And some people do it.

I don't know where people get their money from, but I imagine if you are going to invest in anything, better health should be at the top of the list.

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