Question:
Should I give the doctor money to get a date while my insurance plays around?
I am panicked to get a date no later than the end of Feb. because I want at least 4 months to recover before a big trip that I have booked for the end of June. I know that as of 2 weeks ago they were scheduling in ealry Feb. I'm hoping with the holidays there haven't been too many scheduled. I am very frustrated that my insurance appears to be playing games - asking for the psychiatrist's office notes. If I can't get this resolved tomorrow I am thinking of calling the surgeon's office and asking to be switched to self-pay so I can get a date. In the meantime I would continue to work it out with the insurance and pray it will get resolved before surgery so I can go back to insurance paid. I don't have any money laying around but I do have enough credit available on 2 credit cards to cover the cost. The surgeon's office said they do take credit cards. I'm not sure I am ready to self-pay without one heck of a fight but I'm almost thinking if it came to it I would self-pay and appeal or sue after to get reimbursed. If I miss the end of Feb window I would have to wait till Sept or Oct, which I could do, but I so have my heart set on going forward now that I would be very very disappointed having to wait. I was looking forward to the challenge of being 4 months post-op WLS and finding things to eat on a cruise. Should be interesting. At least i can eat shrimp and crab so I'm sure I'll be fine. Would any of you change to self-pay, using credit cards, just to get a date? I'm just frustrated because it's the weekend and I can't find out what BC/BS has up their sleeve. Any words of wisdom would be appreciated. — zoedogcbr (posted on December 29, 2002)
December 29, 2002
Hi Chris, it's me again lol. I would just ride that insurance company. I
would call them everyday. I would argue with them. I understand your dilema
but, I would not put the cost of this surgery on a credit card. For one
thing, the interest rate. For another, your monthly payment would be so
high. You may or may not have any luck suing them. I know that most docs
do give you a discount if you pay cash. If the trip is one you can change,
it might be wise to do that to save yourself thousands of dollars. Good
luck
— Delores S.
December 29, 2002
My mom has said we could cancel the trip although we would lose the cost of
insurance ($1000 between the two of us). The problem is that my mom is 77
and I'm afraid if we put off this trip another year she just won't be able
to physically do it. It'a an 18 day trip and I know it will be hard on
her. It's 11 days in the Yukon and Alaska and then a cruise the last 7
days. I'm hoping the cruise at the end will allow both of us to recover
some from the first 11 days. This is something we both really want to do
and I don't want something to happen to either one of us and regret not
having done it. I don't know how many more years my mom will be able to
travel or even how long she will be around. So I am pretty set that I
won't cancel the trip. I originally planned to go as a super obese person,
so worst case is I do.<p>It's frustrating because I know I have
insurance that covers this surgery and I know I qualify. I just don't need
the hassle. This should have been cut and dried. I know how long appeals
can take with BC/BS and I'm just not sure I am willing to wait that long
and take my chances. Fortunately the highest interest rate I have on a
card is around 10% and if I did end up having to truly charge it then I
would end up transferring the balance to a 0% rate card for as long as
possible. I would not get by totally interest free but I would be able to
minimize it. I also would be able to shift some of it to my home equity
(who needs a roof anyway) and cash some of it. The thought of paying
$26,000, as I'm just not sure I would want to go out of state to get a
cheaper cost, is scary but not totally out of the picture. It sure would
be a shame considering my insurance should be paying for this. We'll see
what tomorrow brings.
— zoedogcbr
December 29, 2002
Chris, you said you have enough on two credit cards to pay for the surgery.
Does this also include the hospital charges? The anesthesiologist? And all
the other ancillary charges associated with this surgery? What if you have
complications and have to stay in the hospital longer. My surgeon charged
4400. for my surgery, but the hospital charged 40 thousand. And as self
pay, you don't get the luxury of the contracted discounts offered to BX.
Pre-op I wanted the surgery RIGHT NOW too, but please consider the
ramifications of self pay before you choose that path, and please do it
wisely.
— RebeccaP
December 29, 2002
i would lean on the insurance company as much as you can, i didnt get
approved until 430 the night before my surgery..i cried, i begged i had my
employer call and the surgern, and they came though----open 11 days post op
— Alexandria D.
December 29, 2002
Rebecca and Alexandria - The total charge for self-pay is $26,000 including
everything. They have negotiated all of the charges for this procedure.
The only issue will be if I would have complications, what would BC/BS do.
I'd be more than willing to gamble till the night before a surgery waiting
for approval but my surgeon will not even give me a surgery date without an
approval or a self-pay agreement. I can't wait till 8:00am tomorrow to
find out what is going on.
— zoedogcbr
December 29, 2002
I would give the surgeon a deposit. Contact the insurance co, and if
necessary contact the insurance board in your state. The insurance company
should have a policy stating how long it takes to make a decision. Good
Luck and have a wonderful cruise with your Mom!
— Meg L.
December 29, 2002
Although you could change your mind at the last minute, I would be VERY
careful about going self-pay. I had complications from my surgery and was
hospitalized and/or in rehab for most of 6 months. At last count, before
they got the bill for my skilled nursing facility stay, BC/BS of Colorado
had paid out over $180,000 on my behalf this year. There is no way I could
have taken care of that. I know that none of us thinks it will happen to
us, and I certainly expected to be back at work in way less than 6 weeks,
not 6 months+, but it can happen to any of us.
— garw
December 29, 2002
Hi, I have decided to get n with my surgery. The insurance denied me
saying that I didn't have a metabolic abnormality that caused the obesity.
I too want mine done in February. So I decided I wan't gonna fool around.
We will appeal etc. I ust wanted to get a date and not wait 8 months while
they decide and they old stil say no. So I have my date February 10th and
have given them my deposit of 15,000. The total cost is 30,000. With my
money and a generous donationfrom my mother I am able to do this. 42 more
days. Yah!!
— armonce G.
December 29, 2002
Hi, I have decided to get n with my surgery. The insurance denied me
saying that I didn't have a metabolic abnormality that caused the obesity.
I too want mine done in February. So I decided I wan't gonna fool around.
We will appeal etc. I ust wanted to get a date and not wait 8 months while
they decide and they could still say no. So I have my date February 10th
and have given them my deposit of 15,000. The total cost is 30,000. With
my money and a generous donationfrom my mother I am able to do this. 42
more days. Yah!!
— armonce G.
December 30, 2002
I changed my status to self-pay for now. That allowed me to get a surgery
date of Feb. 3rd. I did not have to put down a deposit. I either have to
have a written approval or pay the full amount by Jan 27th or the surgery
will get cancelled. I figure if I don't have an approval by Jan 16th, day
of pre-op tests, that I will cancel then. If this can't get straightened
out in the next 2 weeks then it is likely to be a much bigger battle. In
the meantime I can keep pushing for an approval and have an earlier date
than I thought I would end up with at this point.
— zoedogcbr
January 4, 2003
Well my gamble paid off. I got my insurance approval on 1/3/03. As soon
as the letter arrives I can be switched back off of self-pay status. I
never really intended to go that route as I knew I had coverage, butfor my
own sanity I needed to secure a date. I need to know that I will have lots
of recovery tme before out big vacation in June/July. I want to fully
enjoy it!<p>I appreciate everyone's input. This worked for me with
my insurance - but please future readers of this post don't assume it will
work with yours. You need to be absolutely sure that your policy covers
the surgery and you meet all criteria etc. I knew in my heart it was a
minimal gamble and the only gamble was losing the date I secured, as I did
not have to give them any money. I'mm breathing easier this weekend and
trying to destress!
— zoedogcbr
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