Aetna and my DH's employer....
(I also posted this in the LB forum...
In a phone call yesterday, I was told by a gal from Aetna, that WLS is covered but she mentioned " $15,000 lifetime maximum". That will not cover the 80% that insurance pays. I pay 20%. Has anyone else had this experience? (The cost of Lap-Band at the Cleveland Clinic is around $30,000.)
Update:
I called today and spoke to a different rep on the phone. Yep, my DH's company specifys that there is a $15,000 max for WLS. Wow, that sucks. I am normally a really optimistic person but that bums me right out.
That leaves me with a $15k bill.
In a phone call yesterday, I was told by a gal from Aetna, that WLS is covered but she mentioned " $15,000 lifetime maximum". That will not cover the 80% that insurance pays. I pay 20%. Has anyone else had this experience? (The cost of Lap-Band at the Cleveland Clinic is around $30,000.)
Update:
I called today and spoke to a different rep on the phone. Yep, my DH's company specifys that there is a $15,000 max for WLS. Wow, that sucks. I am normally a really optimistic person but that bums me right out.
That leaves me with a $15k bill.
R. c
on 2/6/09 12:00 am - nashville, TN
on 2/6/09 12:00 am - nashville, TN
Wow, a $15K max sucks! With that being said, you won't be responsible for paying the entire amount of the other half, as there will be adjustments made if your surgeon and facility are in-network.
These adjustments can add up to a good bit. For example: My hospital billed out $42,000, and Aetna paid $28,000.
Surgeon billed $4,500. Insurance paid $2500.
Anesthesiologist billed $2,000. Insurance paid $1,100.
I paid around $3,000 out of pocket total.
The total allowed write-offs/adjustments on my bill came out to almost $14K. I don't know what the allowed adjustments will be with your particular plan, but your part should be a good bit less than $15K. Good luck and let us know how it goes. :)
These adjustments can add up to a good bit. For example: My hospital billed out $42,000, and Aetna paid $28,000.
Surgeon billed $4,500. Insurance paid $2500.
Anesthesiologist billed $2,000. Insurance paid $1,100.
I paid around $3,000 out of pocket total.
The total allowed write-offs/adjustments on my bill came out to almost $14K. I don't know what the allowed adjustments will be with your particular plan, but your part should be a good bit less than $15K. Good luck and let us know how it goes. :)
~* Rosie *~ 2-16-10