Self Pay by DS vetted Surgeon $13k in NJ

I wanted to share this with anyone interested in self-pay for DS surgery.  I am not a candidate for DS surgery through Cigna *****quires a minimal BMI of 50 (I think with Co-morbidities) and this is the only surgery I want.  I was only looking at Mexico as I thought financially that would be my only option when I saw something on one forum or another regarding self pay in Pennsylvania being a reasonable option.  Upon doing more research, I found a highly vetted surgeon in NJ (Dr. Greenbaum) who quoted me $13k for the procedure whi*****ludes 4 days hospitalization, surgery, anesthesia)  the additional things I must get are an endoscopy (my insurance should pay) and a appt with a nutritionist (again - looking to have insurance pay, we'll see.

I spoke to the patient coordinator asking her "is there ANYTHING ELSE that could be an out of pocket expense?"  She said that Dr Greenbaum also does a liver biopsy (CPT code 47000/47100) and a radiological "leak"test post surgery (CPT code 74240/74241 depending).  My next question was - ok what does that cost?  She didn't know - WTF. Luckily, I found a terrific person in the billing office at the hospital that gave PHENOMENAL service and did a couple things - 1) since I was having surgery there they worked on the price 2) being self pay, only paying 12% of cost - she is sending me paperwork for approval and confirmation/documentation that allows me to pay 12% of the cost as a self pay - the 2 additional procedures would cost $2100 and at self pay will cost me $252 - I can deal with that.

I was prepared to go to either Dr. Aceves or Dr. Ungson - whose prices are almost the same but this saves me from flying from Philadelphia to San Diego or deeper into Mexico for Ungson.  Ungson seems amazing too as a doctor yet I don't love flying that far after surgery and at a lower price (unless complications) I have a vetted DS surgeon about 1 hour away.  If I do have complications, Greenbaum says the hospital will cost about $850/day additional.  Luckily, I also have a voluntary plan that will pay $500/day to me when I'm hospitalized for the first 5 days and a surgery benefit then $100/day after that - so that too will help with the cost.  Wish me luck and no complications!!!!  Scheduled 6/30/2014, nervous but I can't wait!!!

Excellent!  Congratulations!  : )

--gina

Great plan! this is a fantastic self-pay price with an excellent surgeon.

If you are up for a fight you might be able to appeal for your insurer to pay, as there is no medical justification for the bmi over 50 limitation. the DS is a standard of care operation for anyone who meets the NIH criteria for bariatric surgery. But it can be quite a fight, and while many people do win appeals there is no guarantee. Your choice - but you do have a great plan in place.

Larra

Lucky you, don't be nervous you have an experienced doctor.

Do not forget to add the $250 for the preop diet that Dr. Greenbaum requires.  This is the protein shakes that I believe you need to have for 10 days.  The cost supports his support groups.  Just thought I would mention that.  I think the price is well worth it, considering I was going to pay out of pocket $6,000 for endoscopic suturing of the pouch.  Glad I decided against it.  See you on June 30th and will see who is first or second.

Cindy