Question about Self Pays

CystaK
on 1/24/08 2:43 am - TN

anyone here self pay the entire amount for surgery? if so, where did you go and how much? I was hoping to have surgery at Centennial but switched insurances and thought it was still a covered procedure but it is not-any of it-no split no nothing-WLS is considered an exclusion for our NETWORK even though the company itself pays for it! So-please help me in this if you have any anwers.....

Darlene H.
on 1/24/08 3:01 am - Pinson, TN

RNY on 02/25/04

I had surgery at Centennial in 2004, I was self pay . I am sure the prices have changed since then, but here are the numbers I paid

Hospital $17,000

Doctor $5,000

Radiology/Anesthesia about $500 (don't remeber the a exact amount) I had to pay hospital and doctor before surgery and the other I paid afterwards. hope this helps darlene

Darlene Hughes

Susan J.
on 1/24/08 3:07 am - Madison, TN

RNY on 01/31/06

Are you saying that your company policy does not have an exclusion but the insurance network does? I'd check with your Human Resources department and/or the customer service number for your insurance for clarification of this. Also, check your printed Statement of Coverage. Unless it states a specific exclusion for weight loss surgery for the treatment of morbid obesity, even if medically necessary, I would fight it.

Susan (AKA bilsrib)
300/135/135 - Plastics February 2008 - Dr. Lois Wagstrom

P E A C E - It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of those things and still be calm in your heart.

CystaK
on 1/24/08 4:06 am - TN

Thanks for your input, Susan... To clarify this is what happened-I had one insurance thru my work when I intially started planning to have WLS. I went to the seminar, found out the requirements and begin to do that. In november, I had a prospect of a new job that my hubby and I were relatively certain I would get. So we decided to take his plan. In doing so, I thought I knew what the requirements were (which were on Centennials info sheet) and they actually sounded better for WLS, so we went with it. Now I am finding out (from calling my member services number) that while the insurance company as a whole covers it, the plan that my hubbys work bought into and agreed to does not. He is supposed to be contacting his HR today and telling them how upset I am. I have also sent an email to Centennial asking them to please warn people that have that network about this issue.

Susan J.
on 1/24/08 5:32 am - Madison, TN

RNY on 01/31/06

Aha, I understand now. The company I used to work for had BCBS of TN insurance but they chose to not include the rider to cover WLS. My husband's BCBS of Minnesota has the rider so they covered my surgery. I am so sorry you found out about this after the fact. That really bites big time. Did you get the other job? If you have changed jobs and their policy covers WLS, you can drop hubby's plan and go on it even if it is not open enrollment for his company. If you become eligible for coverage with your employer, you have 30 days from date of eligibility to drop his as a "Family Event". I hope you can get the insurance issue straightened out. BTW - did you know that Starbucks offers health insurance to even part-timers and their plan covers WLS. Just a thought.

Susan (AKA bilsrib)
300/135/135 - Plastics February 2008 - Dr. Lois Wagstrom

P E A C E - It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of those things and still be calm in your heart.

CystaK
on 1/24/08 6:09 am - TN

Susan-you hit the nail on the head-BCBS of TN-It does bite big time-I wish they would include that in their seminars-that just because the company has it as a general option that not all policies include that option. Did not know that aobut Starbucks-may have to check into that... I am sorry, I cant remember the other responder's name-was it Darlene? Anyway, thank you for your input also. I e mailed Centennial and found that it is: 14, 980 for hospital 7, 300 for surgeon 30 for radiologist reading of chest x ray 3,190 for anesthesia and central line so all total 25, 500-whew!

Susan J.
on 1/24/08 7:18 am - Madison, TN

RNY on 01/31/06

Have you checked at Baptist to see if they may have a better price? I know they give a discount for self-pays. The number for Baptist Metabolic Surgery Center is 284-2400. I had my surgery at Baptist with Dr. Spaw and I absolutely love him and the entire staff there. Good luck with whatever you choose.

Susan (AKA bilsrib)
300/135/135 - Plastics February 2008 - Dr. Lois Wagstrom

P E A C E - It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of those things and still be calm in your heart.

CystaK
on 1/24/08 7:25 am - TN

I havent checked with them yet-did not know if maybe someone here would know-I will call them tomorrow-thanks, again, for your help! BTW, I saw in your ticker that you are going to have plasitc surgery-what all are you having done? Is it to help with extra skin?

Susan J.
on 1/24/08 7:41 am - Madison, TN

RNY on 01/31/06

I am having a belt abdominoplasty with mid-line incision and mons reduction (lower body lift) and I'm also having a hernia repaired. The plastics are to remove the saggy skin. I plan on asking my surgeon tomorrow if she has any estimate of how much she will remove.

Susan (AKA bilsrib)
300/135/135 - Plastics February 2008 - Dr. Lois Wagstrom

P E A C E - It does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of those things and still be calm in your heart.

CystaK
on 1/24/08 7:54 am - TN

KUP on how ti goes and if you like the surgeon when its all said and done-eventually I guess I may have some surgery whenever I get the RNY-I was going to say IF but I am trying to be positive!-LOL GL with your visit!

Question about Self Pays

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Question about Self Pays