Question on Insurance Caps???
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.
(deactivated member)
on 11/30/06 6:21 am
on 11/30/06 6:21 am
the cost for wls out of pocket is aprx 25k depending on where you go what program ect but insurance companies have contracted rates you wouldnt believe some of the rates they have compared to what you would get charged out of pocket for the actual surgery the insurance company most likely wont pay anymore then 10k for 1 time surgery... my personal opinion the cap is probably there so that they dont have to cover another surgery because someone stretched there stomac out ect... the 500 dollars depending on what type of plan you have is most likely the deductable and or the co insurance max for your policy and it means you have reached the max out of pocket for that calander year... i would check with the dr and see if most of the post op visits have been included in the claims for the surgery usually i think most policys and dr's make it so they are but you never know and thats important because in january a new calendar year is started and you will again have to meet the ded and coinsurance for that calender year for everything to be covered 100% if your surgery is in january then this also means that you shouldnt have to pay anymore out of pocket for the rest of the year which is a good deal.... anyway i hope that helped good luck!!!
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