Insurance Cap Question?????
I would appreciate it if someone could explain how insurance caps work. I see that my insurance has a $10,000 cap on WLS. The center that I plan on having surgery with checks out everything that you need for approval with the insurance companies and sent me my list. On that list, they told me that the surgery was covered and I would have to pay $500 out of pocket up front.
I don't understand. Surely the cost is more than that??? Sure hope someone can help explain how this works. Thanks.
Hello!
A cap is a limitation on service. It may be a ceiling on how much coverage goes to a particular kind of an expense during a year.
It may be a lifetime cap that pulls the plug on coverage after a large dollar amount has been reached over years of expenses.
I would ask what the $500 is for. Is that a program fee the center charges that is not covered by insurance? I know I had to pay Deaconess Hospital in Cincinnati $300 for their program fee and it was not covered by insurance. If it is...$500 sounds a little steep.
It sounds like your insurance will cover expenses for your surgery up to $10,000 and then the rest might be your responsibility. I would call the insurance and ask a lot of questions.
Do you have insurance deductibles? If you have a $500 deductible....the surgery center might want that upfront. Maybe that is why they want $500.
Do you have a network that you are required to stay in for full coverage?
Do you have copays?
Investigate before you go any further so you will know how much you are going to have to spend. Also check out if you have to pay separate for anesthesia.
Sandy
The $500 is probably for the program fee that is not covered by insurance. The program fee should cover your dietician, mental health assement, excersise therapist and any other individuals you would need to see within your surgeon's program. If that is what it is for, then it really isn't an outrageous price at all.
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