Insurance help

Lindsayg
on 9/12/15 10:42 am - Kissimmee , FL

Hey everyone , 

I am new to this site Very excited to chat and interact with some of you beautiful one .                                                                         I was told this where Bariatric surgery dreams can come true :) 

I have been trying to figure out how I can make my weight loss dream a reality . The main problem I have is unfortunately I don't have 5k to pay for the Sleeve Procedure . I have insurance United Health Care and I qualify for the surgery they will only cover 70% of the surgery .  I also Have Medicaid (shared Cost ) But I cannot figure out how I can use both , Or Find any Surgeons that will except both . to be honest I am not even 100% sure how that share cost works ?   I'm sure this sounds very strange Or as though I am trying to take advantage of Medicaid . Please don't think that I'm a single mom of two and I just want to get healthy and Fit so I can Whip my son in Basketball with out passing out from doing a Layup :)  

So The point is I could really use some Advice I live in Central Florida and would like to find a Surgeon who can help me Show my son Old Ladies can still School Some young Boys in Basketball :) 

Thank you Lindsay AKA Female Jordan  Wright  

Cicerogirl, The PhD
Version

on 9/12/15 6:56 pm - OH

Actually, probably the best people to help you out would be the person who handles insurance submission for the bariatric surgeon's office.  They handle insurance coordination all the time and will be more familiar with the process and what will and won't be covered (or can find out!).

Good luck.

Lora

14 years out; 190 pounds lost, 165 pound loss maintained

You don't drown by falling in the water. You drown by staying there.

fluffyfrog
on 9/13/15 7:10 am - FL
RNY on 12/15/15

I live in North Central Florida and work for a University hospital. Share of cost works this way.... If your medical out of pocket charges are more than your SOC amount, Medicaid will cover the full charge. Example: your share of cost is $1000. If your total out of pocket charge is $1001 Medicaid will cover the cost. I know our facility does not bill Medicaid until the share of cost is met and you are switched to full medicaid for that month. You will be responsible for submitting your bills to medicaid until it is rolled over to full medicaid. I hope this helped.

Lindsayg
on 9/13/15 7:19 am - Kissimmee , FL

Thank you fluffy frog 

very helpful and considering you are the only person to comment can I rack your brain a bit more . You seem to know a thing or two about a thing or two so thank you ! 

How would you go about this ? I have united health care pays 70% and Medicaid share cost my cost 2k  .  How can I use both of them together ? 

fluffyfrog
on 9/13/15 12:19 pm - FL
RNY on 12/15/15

You let your doctors office know that you have both insurances. They will bill United first. The 30% coinsurance would be billed to you. You in-turn submit the bill to Medicaid. If your total coinsurance is more than the 2K for the month Medicaid picks up the the total bill, that United Health doesn't cover. The problem with some doctors offices are that they will require you to pay the 30%, because they do not bill Share of cost. It's a vicious cycle. If you pay the 30% Medicaid will NOT pay you back. Their thought is if you have the money to pay your share then you don't need the assistance. I know at the office I work for ( a specialist office) we let the bills go thru the insurance. If you do not meet the share of cost and it's doesn't roll over to straight medicaid then you will receive a bill. Also check with the hospital you decide to go with. They may offer a financial assistance program, or a payment plan.

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