how much did your insurance pay for panniculectomy?

I mean, if you had your insurance cover some. Was it with a doctor who was in network? Just trying to get a rough idea here. I got approved, but the two surgeon's i talked to (both contracted with my insurance) told me i'd have to get the amount from my insurance, and when i called them, they told me the doctor should tell me...so... i'll be trying more phone calls later but was hoping you guys would know. Thanks!

Hi. I was just curious.. What insurance do you have? I am in the process of trying to find out if I am approved for a panniculectomy and my insurance is based in California. It's obviously medically necessary.. Just waiting on the dr's office to send it into my insurance company for approval.
On your question, I would look at your policy.. When they approved it, did they say at what percent? 100% or what? Then whatever the fee would be it would be whatever the ins. company's percentage is covered. I would also think that the dr's office would have ins. specialistes there to call your insurance to take care of all that.

I have Anthem blue cross, PPO, so it covers 80% in network, 60% out of network. However i'm having trouble getting anyone to give me numbers on the cost of the panniculectomy itself, to know just exactly what to deduct that percent from! it just seems really stupid to me as to why these surgeon's don't know....i mean they are contracted with my insurance so that means there is an agreed upon amount they bill for that procedure, i just can't get anyone to tell me what that amount is!

I have the same insurance you do.
I would call the surgeon's office and speak to the insurance specialists there (billing, etc..) They should be able to give you the amount for sure. Good luck and keep me posted! 
p.s. was it easy or difficult for you to get approved? 

My insurance picked up nearly everything.  But, prior to the surgery, I was advised that they might not pick up one portion associated with my tummy tuck and they were able to disclose the prices for each portion of the tummy tuck, panniculectomy, hernia repair, etc. (within certain limitations) and what my insurance should cover, with the sole question being the waist draw-in (there's a medical term for it, it just escapes my mind).

If this is a PPO provider, they should be able to do the same for you.

I have Pacificare and they covered all of the Panni removal + muscle repair.  Mty Dr was in the network.  You shouldn't have to pay out of pocket, but they should charge the insurance directly like they would for any other surgery.

Zip - Zero - Nada - Nothing. 

Often 2 overlooked items on the benefit summaries are deductibles and out of pocket maximums.

First I would review your summary to find out what your deductible is.  Your insurance will pay their 80% of the negotiated rate (assuming you are in-network) after your deductible is met.

What remains is your 20% co-insurance, however, you would only be responsible for 20% up to the out of pocket maximum.  Double-check to see if the deductible is included with the out of pocket maximum (typically it's not unless you have a health savings account compatible plan).

So if your deductible is $500 and your out of pocket maximum is $1,500 (not including deductible)...then you'll know that the most that you will have to pay for this surgery is $2,000.  If you get labs done for pre-op or other items where you need to contribute to your deductible or have a co-insurance, then that will be applied to your out of pocket maximum, too.

Keep in mind that Co-Pays and Co-Insurance are two different things and the best way to remember this is that Co-Pays=$ (straight dollar amounts) and Co-Insurance=% (a percentage of the charges).

Hope I didn't confuse you but those would be good questions to ask when calling your insurance for payment information.

I'll crawl under my health benefits analyst desk now. :-)

Cheers!
Tisha

My surgeon billed $2600 and the agreed upon amount thru the insurance was $1462.35 my portion was $146.23 w/ my co-pay (I had empire blue BCBS out of NY). Funny, my surgeons office knows exactly what each insurance company covers. They actually gave me my estimate for the LBL & Brachio w/o the panni part included (just glad it got approved after an appeal)

I tried to send you a message but your profile is private..woudl you mind sending me a message so I can maybe bug you and ask you some questions??