Yikes!$4900.00++ Cash?????

I am using Dr. JK Champion who is not in contract (network) with any Insurance Company, so I realized that I would have to self pay 20%. Finding out that, 20% would be 4900.00 was a surprise. But today I found out that my Ins. BCBS of Georgia POS, will only pay 80% of the Usual and Customary Fee, of the hospital bill. (even though the hospital is in NETWORK) because my doctor is out of network. That was a shock. They will also only pay 80% of anything that he orders for me. I don't know what the hospital fee will be, so I don't know if I can pay the 20%. Does this make sense to anyone and could you help me figure this out? Maybe someone has used BCBS of Ga. for their surgery and can tell me what you wound up paying out of pocket all together. Meso

Meso Thin, I have BCBS HMO and my insurance paid 100% of the cost. I had to pay a $200.00 admission copay. Best Wishes Tammie G.

Meso, You might have to find an in network doctor. The whole coverage will probably change. One office I called said it ends up being around $40,000.00! I wish you luck with this, its a real shame that insurance companies have so much control over our health. Barb

When I started my journey about a year ago the Dr I wanted to use initially was on my insurance, but none of the facilities that he operated at were HCA facilities. My insurance covers me at 100% if I use one of their facilities. I had to find another surgeon on my list that also used an HCA Hospital. I never saw the initial surgeon, but I was so glad I used who I used. He has turned out to be fantastic. Anywhoooooo, everyone I know who has had BCBS Ga has been in network, and their surgeries have been paid at 100% Susan LAp RNY 12-1-04 285-232-155 (-53)

My question to you is this. Why do you think you have to use this Dr. Champion. I had my WLS surgery in Brunswick, Ga. by Dr. Harold Kent. Brunswick was closer to my home is why I originally selected this team of surgeons. My insurance paid for the surgery because Dr. Kent and his partner are in "network". However, choosing Dr. Kent was God answering my prayers. I couldn't have asked for anyone better. But I have some friends in the Atlanta area and the Macon area that have used the services of other surgeons in the Atlanta area and their insurance providers paid for the WLS surgery because the surgeons were in "network". And all these people's surgeries were very successful. My suggestion to you is to find you a surgeon that is in "network" for the insurance you are paying for. Why pay for insurance and not reap the benefits. I believe you can find a surgeon that will be in "network" as far as your insurance is concerned and will be just as competent as Dr. Champion. Now, I am in no way saying he (Dr. Champion) is not competent because I know nothing about him. I have BCBS Fed, and that is a whole "nother" ball game, so I can't help you out with the cost part of your question. I wish you all the best in this journey. I had my surgery March 02, 2004 and have lost 175 pounds. And, yes, it has ALL been worth it. Hope this has in some way been helpful or at least given you something to think about. Good luck on your journey. Let me hear how it goes. Marlene

I used Dr Champion for my surgery and i also went throught BC/BS of Georgia. They made me pay $3500.00 up front just for the surgery fees. The hospital was in network and all i had to pay was $100.00 to the hospital. Now the insurance is saying they will only pay for $1300.00 for the surgery. If the insurace will not cover the balance, i will have to come up with another $2500.00. I used Dr Champion and i understood that i might have to pay more, its all a choice and up to you. I chose Dr Champion, because i thought he had a great aftercare program and it was best for me. If i can help you with anymore questions, feel free to contact me. Good Luck. Robin

HAVE YOU THOUGHT ABOUT CHANGING DOCTORS I HATE TO SAY THAT BUT I ONLY HAD TO PAY 200.00

Well, if you want the best, you pay for the best. Look at some of the other Dr's complication rates.. 3 people on this board have lawsuits against one popular surgeon. I used Champion, and I had to pay 4600 out of pocket. He's worth it. I felt that I wouldnt settle for something like this by using someone who was in network.. I felt he was the best and I felt I was worth it. OUt of 2000 surgeries he's had 3 deaths... that's astronimically good statistics. Alos, you will never pay for a post-op visit - EVER. His aftercare is the best - hands down. (In my opinion, of course) I've seen how some other patients here get treated by their surgeons, and I've never felt nor heard of anyone being treated that way at his office. granted, his bedside manner sucks, but I refused to put my hands inthe life of someone because they were in network. In closing.. if there is a way you can afford it, pay it. For the record, - I paid 4600 to him 250 to the anestheiologist 2k for hospital (they worked out a payment plan with me) and I didnt have any presriptions to pay for.

My insurance at the time was BCBS it was also 80/20. I paid the Dr. 800.00 but he was in network. I also paid the hospital 225.00 and I have never got a bill from the hospital. My bill from the hospital for one night stay was 47000.00 total. Michelle

For some, $4,900.00 may not be an issue, for others it may be a procedure stopping obstacle. There may be many gifted and reputable Bariatric Surgeons who are "in network" on your policy that may be worth considering.Whatever you do, don't let this financial dilemma delay this life saving procedure even by one day. Make a decision as to whether to cough up the money or move to an in-network surgeon and continue forward. The way the insurance companies concoct new ways everyday to bog you down, you just can't stumble, you've got to keep moving.