Legacy question

Does anyone know: If my insurance denys surgery... will I have the option to pay for it?  and if so, does anyone know the approximate cost?  if insurance denys me I don't want to go through everything again and I'd rather just pay for it. Also, does anyone know how long it takes for the surgeon's office to call and schedule your appointment after you get referred over?  I am going in for my final weigh in on the 4th and will be referred over after that! thanks!

I went to Dr. Tersigni in Coos Bay and I was charged 10,000 for the surgery and then 360 for the nutritional class, 200 for the doctors visit and 216. for the drink test the day after surgery.  So about 10,716.00 all together.  Pretty reasonable considering they are charging 17,800 in Medford and Dr. tersigni trained them.  I opted for private pay simply because I was not willing to go on one more diet for a year, insurance requirement.  Hope that helps.  Oh, I had my initial appt. on Nov. 5th and because I was going on a cruise, delayed the surgery until Dec. 14th.  Pretty quick, when compared to what I am hearing goes on at Legacy and OHSU.

Gosh, if my memory serves me correctly, it took a week or two for them to call to schedule my consult with the surgeon.  I also think if you have come this far, and they haven't asked you for any $$ up front, they are pretty sure your insurance will pay.   Not sure which surgery you are having.  They bill my insurance about 18,000 , and haven't received a surgeons bill yet.  I had lapband surgery.  Just be patient...........it should all come together....and you will be on your way to the loser's bench!

My insurance had exclusions to all bariatric surgery.  I am a self-pay bypass pt and my surgery was 1-11-08 OK,,,here is what the costs are legacy weight loss- 1300.00 OWLS- 8400.00 anesthetics- 2000.00 Legacy hosp- you must pay 60% which was 18,000.00, then you may pay without interest the remaining 10,000 as you can. All of these are upfront payments before surgery, the only good thing about paying self-pay is that you get into the surgeon QUICK, my whole process took about 5wks.  OWLS does also have a insurance program that you inroll in that will cover any unforseen complications that may arrise, before, during, and after the procedure up to 3mo. that gave me a sense of security going in....because I told Dr. Jan, if something happens to me on the table, you just leave me there, because I cant afford anything else.  My surgery went VERY well, the staff at Legacy was very good and 3wk out in down 27lbs.-  Iwouldnt have cared if it cost me 50,000- we are all worth it, unfortunately the insurance companies still dont see WLS benifits outweight the cost yet. good luck Carolyn

I went thru Kaiser Permanente, and they paid 100% of everything, except for any medications that I needed which were only $5.00 a piece.  I am 17 months out and minus almost 280 lbs. Peggy

Thanks everyone for all of the suggestions. I guess I should have been more clear on my question. I'm currently pre-approved.  But not approved for surgery.  I'm going through the pre-approval process through BCBS and I was wondering if anyone has been through this and then had insurance deny at the end... after your visit with the surgeon.  I'm currenly just paying my 15%.  But if I get denied I was hoping to just cover the rest myself.  And hoping that'd be an option.

Sarah, I didn't have an issue but, when I received my approval letter from BC/BS, it actually said they were basically conditionally approving the surgery.  In other words I had the surgery without knowing if they would actually pay for it. You may want to discuss this with the insurance coordinator.  They may be able to negotiate price.  In Oct. 2005 I believe the cost (before insurance deductions and such) was around $35,000 for lap band.  I don't think the price has increased that much (heck, maybe even decreased?  one could always hope). You'll always have the option of paying for surgery if something like a denial where to happen after the fact.  But the price, well, I don't know how much leverage you'd have for negotiation. I think a good question to ask the insurance coordinator is have they ever had this happen before where an approved candidate was later denied insurance payment and how did the clinic handle it... Good luck! Lori

I am self pay through Legacy.  I am having surgery and all appointments in Vancouver at SW Washington Medical Center.  Oregon Weight Loss Surgery partners with them.  It is about $3,000 less to have it up there. Jay Jan will be doing my surgery.  Total I will be paying is about $20,000 give or take.  I had my primary care physician order my sleep study and labs.  Insurance paid for the sleep study and I am waiting to see if they will pay for the labs.  That saved a bit of money. I hope this helps.