Insurance question? Limit

Hi everyone: I was reading threw my company insurance paper work, and it say that they have a $10,000. limit..... for WLS........ in a lifetime. What does this mean? Has anyone delt with this and how would I get around this to have surgery done? Thanks for all great info. Mary

I never saw a clause like that, but you better find out because my hospital bill was $16,000 and they adjust about $4000 so you would need to come up with about $2000 more plus the doctor bills unless they are covered separately. My part of the hospital bill was a whopping $72.30. Phew!

It means that all they will pay is $10,000. However, if you have a network type plan and the doctor and hospital are in the network, they may have contracted with them for a lower rate. Bottom line though is that if they have a limit, it means that's all they'll pay.

Hi Rob: Smiling thanks that explain more to me. I did call office of doctor and they said in plan. and that they neg. over payments when in plan. And they did not seem to be concerned. I think I am just scared after experience. I went to bart. treatment center here in MI 1st. And in mean time found this office, and was going to change. Bart. treatement center calls and says basically to pay them $15,000. more and they would do surgery. I cracked up. And thought well sign go to other place. So I did, and I told them about limit. and the girl said they neg. over payments in plan.. So maybe just me scard........ LOL Thanks for all info Mary

Mine was a little different - as Rob said, my current surgeon AND hospital were "in network" for my RNY, so my insurance covers all costs at 90% (I'll have to cough up 10%...ouch!). But I'd initially gone to a "bariatric center" that I just assumed was 'in network' because of their 'fame' - the PA called me the day before my PATs (I was scheduled for Lap RNY in their facility for 1/28/04 already) JUST to 'make sure' I was aware that neither the facility NOR the surgeon were "in network" and I'd have to pay whatever the overage was on what my insurance WOULD cover tp them. OMG...I was FREAKED. (AND my biggest question was "why didn't you catch this four months ago?!?") I called my insurance co. and they told me I had a "catastrophic limit" of $10K, so that's all I'd have to pay PLUS my $500/yr deductible. ~ALL~ I'd have to pay? There's no way I could come up with that kind of money, even on a 'payment plan', so I had to switch surgeons and hospitals if I were to have the surgery. It was just God's way of saying "Right surgery, wrong way to go..." That's how I found my WONDERFUL surgeon and hospital, and I'm covered at the fullest my insurance will cover ANY surgery. I now know that if anything like this comes up in the future, that I'm gonna READ my policy, call them for details, and not "assume" anything. Kimmer Queen of the Niners, Instigator to All Marchers, High Priestess of Giggles

Hi Kimmer: Smiling like you I went to Bart. Treatment Center here in Holland, went threw interview. ANd few weeks later they called. said my insurance has max of $10,000. and the would give me there discount and I would only haft to pay up front $15,000. cash. I cracked up said yea right have that right in my back pocket. So in mean time i heard about MMPC. in Grand Rapids. My insurance is a PPOM threw CBSA. and they are in program with them. I hope everything goes right. I am nervous. I already knew from first meeting that I would pay $900. and that is not a big deal. Just hoping that when finally schedule a date they don't come back like Bart. Treatment Center and want my life and kids to go with it LOL Wish me luck, and thank you so much for information............. Mary