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Abibliophobe

Insurance stuff?

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I got paperwork from my doctor for the consult and it said things like I might have to pay a deductible/surgery fee when I get to the surgery part of every thing (post on surgery) and then it said I might have to pay a fee for the hospital kind of like a down payment.  

 

But,  I'm curious when they will be able to determine this.  I need to start saving in case that is the case but I don't know how much money I'll need.  

 

I honestly don't think I'll have a fee.  I might for the surgery but I don't think I will for the hospital because I called my insurance company and they said that I would get the hospital stay whether it's inpatient or outpatient at 100% coverage. They didn't say anything about a fee.  They didn't know about coverage for the actual surgery though because they aren't provided with that so thats a little iffy.    

I have an hmo and it's supposed to be pretty good insurance.  So,  I'm trying not to stress but unexpected costs would not be good. 

 

Also,  when do you know that you got approved for the surgery? After the six month diet and psych evaluation and endoscopy are recorded?  I would assume so and I would also assume that I'll have to be on top of the patient care coordinator to get everything in.  

 

From what I know my doctor likes to keep everything in the office.  Like,  we go to a therapist they have there.  We go to get in endoscopy with a place they have approved of etc.  The paperwork also said that the psych evaluation might not be covered, has this happened to any of you? 

 

Last time I went through the process my insurance paid for it but I'm using a new insurance.  

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HMOs are a different beast. I had a PPO, put down a deposit, and settled the balance after the insurance paid its portion. You should have minimal financial exposure, and there shouldn't be any surprises as long as you stay in network. 

Most people have PPOs, so the letter you got is probably standard language. It couldn't hurt to confirm that all of your providers are in network, though. Anesthesia and pathology are two services that come to mind that frequently don't contract with the insurance companies.

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12 minutes ago, WendyH said:

HMOs are a different beast. I had a PPO, put down a deposit, and settled the balance after the insurance paid its portion. You should have minimal financial exposure, and there shouldn't be any surprises as long as you stay in network. 

Most people have PPOs, so the letter you got is probably standard language. It couldn't hurt to confirm that all of your providers are in network, though. Anesthesia and pathology are two services that come to mind that frequently don't contract with the insurance companies.

How do you go about finding  out if pathlogy(is that blood because I have a place I've gone for years) and anesthesia are covered.  

 

I'm almost positive that this place accepts my insurance.  When I talked to the patient care coordinator she didn't say otherwise.  Should I call and ask? 

Also,  how long will it take for me to know I'm approved?  Does that happen during the six month structured diet or after? Im assuming it happens after they've gathered all the information.  

Sorry for all the questions.  Im just trying  to get as informed as possible.  

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5 minutes ago, Abibliophobe said:

How do you go about finding  out if pathlogy(is that blood because I have a place I've gone for years) and anesthesia are covered.  

 

I'm almost positive that this place accepts my insurance.  When I talked to the patient care coordinator she didn't say otherwise.  Should I call and ask? 

Also,  how long will it take for me to know I'm approved?  Does that happen during the six month structured diet or after? Im assuming it happens after they've gathered all the information.  

Sorry for all the questions.  Im just trying  to get as informed as possible.  

Every bariatric program has an insurance expert whose job it is to get people approved. One of my daughters is the insurance expert at Massachusetts General Hospital in Boston.

Edited by tmcgee

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