Insurance option questions. Please help!

Hi all.  This is my first post here.  I am (very) strongly considering surgery.  I've had a consult with one surgeon, and have already done some of my prerequisite things (psych eval, full blood panel, two months thus far of supervised weight loss)

I recently changed jobs, and am about to change insurances however and I have a question...

Two plans are offered through my employer. Both are BC/BS of Arizona. One costs $98 every two weeks, and includes a $500 deductible, $4,500 out-of-pocket limit, and 20% coinsurance.  The other has ZERO employee cost, but a $3,000 deductible, $5,000 out-of-pocket limit, and 10% coinsurance.  Both have a $1,000 "access fee" for bariatric surgeries.

I'll have coverage effective 8/01. Renewal is January 1st. I do not know if having the surgery by 1/01 is possible. What should I do? I was a psych major, and suck with numbers, so trying to crunch numbers to figure this out is difficult for me.

Thanks so much in advance!!!

In order to crunch the numbers, we need to know the cost of the surgery and whether the out-of-pocket limit includes the deductible and/or the coinsurance and/or your premiums and/or the access fee?

Thanks, Mary.  I don't know the specifics of the insurance plan yet.  I'm hoping to find out soon.

it might help for you to talk with the insurance coordinator at the surgeons office and to the insurance person at the new job 

I was luckily given a "case manager" for surgery who discussed all options with me.  I have BCBSNC and basically was told my deductible is 500 and out of pocket maximum is 1500, add them and I should only pay $1200.  I had to pay my surgeon around $350 upfront and have been billed around $1000 so far.  I started the process and completed the surgery all in about a month in a half.  Now about 5 weeks later I am finding out insurance troubles, for example, an appropriate referral for my sleep study was not provided by my PCP so they charged me $1200 (still trying to get retro referral/approval to cover that).  I would suggest to ANYONE to speak with your PCP, insurance dept with surgeon, AND your personal insurance to get in writing all that you need to do for coverage and how much it would be!

Good Luck!

OR...you can go to Mexico for under 5k, skip the sleep studies, not jump thru hoops, & be ready to go in a few weeks. I was fighting with BC FL for the privilege to pay $4400. copay + extras & they denied me... I needed a revision from lapband & they will only pay for " 1 bariatric surgery per lifetime". My lapband was 13 yrs old, disconnected at the port, diff. ins & diff. state.... There are options.

Oh yea! I heard some people were getting them done in Mexico, wasn't sure what the difference was as far as care and quality, but def heard it was cheaper!

Thanks for everyone's input thus far.  Going to Mexico for surgery sounds FAR too risky for me.  :(

I have BCBS AZ as well, though no access fee and I think $1500 out of pocket.

When all was said and done, I believe my surgeon billed about $25k to insurance. So under each plan:

Numero uno: $500 deductible + (.2 * $24500) + $1000. 20% of surgery cost is $4900, so you would hit the out-of-pocket max plus access fee (if that doesn't go into deductible?). Grand total $6k, plus $2500 in premiums per year.

Numero dos: $3000 deductible + (.1 * $22000) + $1000. Grand total $6.2k, don't think you'd hit the out-of-pocket max.

Based on that, I'd be inclined to take the second since you wouldn't have the premiums taken out of your paycheck. Would it be possible to talk to someone in HR before making your decision, though? You can always say that you "might have surgery in the future," this is how much it roughly costs, which would be the best option?

I have a meeting with our HR Director on Monday for something totally unrelated.  I'll try to bring it up then.  Thanks!!