Insurance/Out of pocket expense questions

Happy Friday, all!  I have a couple of questions for those of you who have been through the process.  I have insurance coverage for WLS.  Providing that I get approved, what kind of out of pocket expenses am I looking at?  How much did your insurance cover, and what are the things that they did not cover at all?  I appreciate all of the question-answering you have all given me so far...you've been so nice and helpful!

Thanks,
Heather

Heather,
I haven't had my surgery yet, but I had to pay $1000 to my doctor's office for things the surgery would not pay for.  I'm not totally sure what all that covers, but that is part of the deal when you sign up for surgery with my doctor's office.  I also had to buy the presurgery and post surgery food.  My insurance has a $250 deductible for going into the hospital, so I know I'll have that.  My insurance usually pays at 80%, however because I have had other procedures and two CT scans this year, I have already met my maximum out of pocket.  After all is said and done, I will have paid close to $1800. 

Hope this helps a little,
Greg

Thanks for the info, Greg!  I am most likely going through Grand Health Partners as well, so what you've told me is very relevant for my situation!!  Now, for the $1000 you had to pay, did you have to pay that all up front when you signed up for surgery?

Heather

No they didn't require it up front.  If I remember right I paid $50, then $250, then $700, but at the visit for the $700 you also have to buy food which for most people is around $150 as well.  I also heard they have payment plans.  I didn't ask which I probably should have as I put much of it on one of my credit cards.  When you go to orientation they have you sign a form that you would be willing to pay $1000.  If you decide to go there, on one of your appointments be sure to go to the store and get a sample pack of the food.  This way you can try most of it, that way you'll know what you like and more importantly what you don't.  If you have any other questions, please feel free to email me.  I have 11 more days until surgery and I can't wait.

Greg

OMG.  SERIOUSLY???   What about those of us that RELY SOLELY on insurance for these things?  I will have an 80/20 thing (BCBS Anthem/Kentucky), but my entire outlook for this has just gone into the gutter. 

My husband's hours were cut due to the economy so just saying, "HEY, can I give you CASH for that $1000???" is not even CLOSE to an option.  I am a stay-at-home mom and honestly, we are lucky to clear $30K/year PRE-TAX!

Why do we have to have THEIR food?  I mean....HELLO.  If I could afford THAT, I could've opted for Jenny Craig or some other BS like that.  INFURIATING. Who can even make a payment of $250????  Please. 

So that means.....I would probably be SOL on this, right? What a bunch of CRAP!

Carrie,

You need to really look at your health insurance.  It is 80/20 but is ther a cap on the amount of expenses before it is 100%.  Is there different coverage for different docs?  Shop around and find out where you get the biggest bang for your buck.  Talk to the insurance billers in each office.  They were able to tell me right away what I would have to come up with. 

Don't totally feak out yet and call it quits. 

Best of luck

Pam

Hi Heather.  I had my Realize banding surgery done at Barix Clinics in Ypsilanti.  I have MESSA Blue Cross, and they pay 90% for ambulatory surgery.  I believe that kind of means outpatients.  I was only in the hospital for my surgery for six hours, start to finish.  No overnight stay.  My out of pocket was $944.00.  I didn't have to buy any of my protein supplements through them.  I mostly checked online for good deals and bought mine that way.  I had to pay it on the pre-op testing day.  I didn't have that much cash, of course, so I put it on a credit card. 
Good luck with everything.
Kat

Hi there. I have BCBS of Michigan and went through Grand Health Partners. I had to pay an upfront fee of around $600 which covered all of my appointments with the company for the next year.  (Dieticians, exercise physiologist, PA).  Also I had to pay for food pre op and post op out of pocket which was to be expected so I dont think any insurance company will pay for that. My whole surgery was  covered I didn't have to pay a dime!!! Good luck with the process and I hope everything goes well for you!

Heather,

I had Blue Cross and they paid 100%.  I did have to pay for the  psych consult up front but got back 90% of it.  My surgery was 6 years ago so I guess I was lucky.  Now...not sure what BC pays.  You can call your carrier and ask.

Good luck,

Robin

I have United health and went through Barix.  I paid my $15 co pay for my initial appt.  Everything else was paid 100%.  No pre op diet food.  I only pay now for my annual visit.

Pam