Magna Care

I have Magna Care insurance and they are telling me I have $30,000 lifetime limit on bariatric procedures.  they pay 90% in network, 70% out of network.  My surgeon in out, my hospital is in, my anes. idk.  They also said whatever is billed is applied (after a letter of med nec. and approval) gets deducted from the 30 and I cover everything after.  I was considering the sleeve, but I was told that it would be ALOT more out of pocket expense, so I though I would scale back to the band.  has anyone delt with this issue before?!?!  Magna care refuses to give me numbers and so does the dr's office!

I have the state health plan (NJ Plus) and my surgeon was out of network.  For his patients, he works with those who are in network ans well as those who are out of network.  I am pretty sure for most physicians they overbill insurance companies for patients who are out of network in order to get paid the same amount of money as in-network patients.  I did have to pay out of pocket but not a lot (seriously, it wasn't much and you can PM me for the exact number).  

Your surgeon might not want to discuss specific numbers but maybe he can explain how payment works and what you will be responsible for and what you won't be responsible for.  I think most surgeons or their staff will explain to you what is possible and not possible depending on your health insurance plan.

What I would watch out for are a couple of things:

I know your health insurance company said there is a $30,000 max cap but is that just for the actual procedure or does that also apply to related procedures as well (i.e. endoscopies, lifetime blood tests, complications from surgeries).  You want to find that out now so you don't get stuck with a huge bill later.

I know it seems like your insurance company is really limiting the procedures available to you but don't let cost determine which procedure you will have done.  Any WLS procedure is meant to be a lifetime procedure so you don't want to do one procedure due to cost only to later regret it.  I know that is easier said than done but while revisions are possible, I can't imagine why you would ever want one.

 

The $30,000 is a lifetime pre and post ma cap.  It applies to all related procedures as well.  Hopefully I will talk to the doctors office today.  .....This is just so frusterating