Self-Pay Options w/ Dr. Afram (DC)

Hello- Does anyone have information on self-pay options?  I am strongly considering Dr. Joseph Afram in Wash. DC but am currently having insurance difficulties.  Any general information as to financing, payment options, etc. would be appreciated as well.  Has anyone had to self-pay with him or any other local surgeon for that matter?  How was your experience?  Any and all input is greatly appreciated.  Thanks in advance. -CollieMac

Hello~  Just wanted to ask what insurance difficulties you were having? I too see Dr. A and the staff is wonderful taking care of all insurance formalities. Is it not a covered benefit? I've heard that  in alot of cases ;-( If so that stinks.......it's a high ticket surgery, somewhere in the $20,000 range. That is if everything goes as planned. I know with my insurance it is a covered benefit ( $ 100.00 deductable) but the center charges a fee of $1850. for the psychologist, nutritionalist, trainer and all the support meetings. Good Luck and don't give up, even if insurance wont cover.

Thanks.  My insurance has written an exclusion.  I'm also considering Mexico but I would prefer to not go out of the country.  I've attended one of his seminars and was very impressed my him and his staff.  They let me know immediately that my insurance company does not cover.  I"ve been trying to get in touch with Bernadette to discuss self-pay options but haven't heard from her.  I feel like I'm exhausting all my options but I'm not giving up.  I NEED this surgery and anticipate having it in December.  Thanks for the info. though. -CollieMac

Hi CollieMac, I'm still pre-op, but I can share my experiences so far as a self pay. I did explore insurance coverage and the term "medically necessary". In the glorious land of Carefirst HMOs, you need to be dead before you can be approved for WLS. The good news is most of the testing leading upto the surgery IS covered AND in my case several of the tests were deleted after some extensive questions during my first appointment ie the sleep study and the stress test.  GBMC offers a great packet that explains costs.My office has a one time fee that is up front. The big things I took away from the packet were there will be several bills. One from the surgeon, one from the anestheiologist, one from the hospital, one from the surgeon who will install an IVC filter pre surgery to prevent leg blood clots from getting to my lungs, one from the psyche doc, and one for lab costs. It can be overwhelming. There is a discount for quick payment. I have a folder with everything I've accumulated and it must have 100 pieces of paper so far. If you need to finance things, Capital One has a surgical program. Some of the plans have zero interest. Remember to document each thing you pay for. It all counts towards a medical deduction on your income tax if you itemize. I hope this helps, Mark

Thanks Mark.  I'm looking into everything possible at this point.  Good luck to you.

-CollieMac

Hi Aime, Thanks ! Thats great to hear. I wish Carefirst would cover mine. Have heard Kaiser Perm is a good one, but I didn't want to leave my primary.  We also renew in January so I'd have had to wait another year. One day the insurance company will be required to use doctors to make coverage decisions,,,not bean counters Mark

I was self-pay. It cost me approx. $17,000.00 for open rny, small three inch scar. My insurance said they would not pay anything for the surgery. They did cover my pre-op stuff but they didn't know it was for surgery.  I wish I could have done it sooner. It has been four months and I have lost 63 pounds. I feel so much better. I wish you much luck on your weight loss journey. Take care, Wanda

Good information Mark- except I am insured by an HMO. The only thing I paid for was the program fee. I had no problems with approval. It depends on the situation of the individual I expect. Love GBMC's program!!!