Cross post...Questions about deductibles/copays

Hi!  I'm in the process of getting approved for the VSG surgery.   With my insurance, I have a $2000 deductible for surgery and 80/20 with a max out of pocket of $5000.  I'm curious how much my VSG might cost.  I know I'll have to get exact numbers from my surgeon, just looking for ideas of what to expect!  Also, does anyone know if you normally pay the deductible up front, or after surgery?  Thanks so much!

Rebecca

Hi Mrsnate I think it depends on your insurance. My surger is 9/28/11, yesterday I recieved a call from hospital asking for a deductible then she change her mind and said wait I think we will bill you after your surgery.Her reason was if I had paid more thur the year I did not have a deductible. so I think it has to do with your insurance plan it can go either way.

I have a PPO and had my procedure at the University of Chicago hospital. My copay was $567.00 and my total hospital bill was $65,000. I did opt to stay a second night
at the hospital although they wanted to discharge me after one niight.

Im not sure, but I know with my insurace which covers 80% I have to pay 3400 to the hospital and then I have to pay $1300 for the program fee, to the surgeon.

In my experience, hospitals want the deductible up front.  Now sometimes, you may have already paid part of your deductible to a doctor or whatever, but because it hasn't passed through your insurance yet, it doesn't show.  If that's the case, whoever you paid the deductible to, will give you a refund once everything has gone through.

From what I've read on VSG cost with insurance, if I were you, I'd be prepared to pay the entire $5000 once all is said and done ($2000 of that being your deductible). I mean, that's just the worst-case scenario.  But you shouldn't have to worry about the rest until after surgery.  And many times, hospitals will set up payment plans to help you out, and many will offer a cash discount if you can pay the balance all at once.

I do recommend though, that you make sure that EVERYONE is covered by your insurance. (Anesthesiologist, labs, etc.) Just because they work at an insurance-approved hospital, doesn't mean that they are "in-network".

Another thing to keep in mind is that if your medical expenses are a certain percentage of your income in a year, they may be tax deductible.

Thanks so much for all the advice!  I was preparing myself for the maximum out of pocket anyway, but this gives me more of an idea of what to expect.  Also, making sure everyone is covered "in network"...how do you know who will be assisting and stuff?  Do they plan that ahead of time? 

Thanks again,
Rebecca

I'm actually not sure how you would know, but I would ask when you're pre-admitting...they may be able to help you.  I just know that I've received EOBs from my insurance before, that about gave me a heart attack because, for example, the ER doctor was not contracted with my insurance.  I mean, really?  Who's gonna think to ask that, when you go to an In-network hospital for an EMERGENCY?  Fortunately, they accepted what the insurance paid them.