Question:
Out of Network Surgeon
My primary doctor is also a Bariatric Dr. who works primarily with a Bariatric Surgeon. The closed hospital for surgery is two hours away for me. I talked to my insurance and was told I could choose an out of network surgeon. The insurance would pay 70% and I would be responsible for 30%. Any ideas how much WLS costs? Should I try to get into the hospital which is 2hours away? — sweetcheeks194 (posted on November 26, 2007)
November 26, 2007
Call the Dr and ask, they have a set price if no complications, mine was
$27000, i seen others in my area as much as $30000, but they will tell you
over the phone.
— dapoohster38
November 26, 2007
My husband recently had lap band WLS which I think is less than the other
types of WLS -- we live in PA but went to the approved WLS clinic in NYC --
2 hours with traffic. We could have gone out of network but decided we
would have enough to pay from all the other testing that you have to do
through to get approved for the WLS -- so far the 2 hours was not too bad
only went 3 times and fortunately the doctor has an office in NJ so it will
be a little closer for follow up appointments.
— keren1527
November 26, 2007
I live in Louisiana and both my husband and I had lap band this year and it
was 18,000.00 for each which included all follow up and fills. We have
federal BC/BS and they covered in 100% because we both had over 40 BMI and
co-morbidities.
— cleofet
November 26, 2007
I had the RNY surgery. My insurance did not pay a penny of the cost. I
paid 27,300 in advance. 17,500 went to the hospital and the remaining to
the surgeon and anesthesiologist. The hospital did bill me an additional
3,000+/- after I was home from the hospital. I don't know if this helps
you or not. Since I was self pay I chose the surgeon I really wanted. I
have to say it has been worth every penny!
Good luck with your decision.
Kim
— itsjust4me
November 26, 2007
My insurance company "routes" most RNY patients to an outside
specialty practice. I'm glad they did, even though the hospital is almost
1 1/2 hours from my home. It could save you a lot of money, and these
specialty hospitals that routinely do RNY surgeries have a staff specially
trained to deal with your needs.
— Dave Chambers
November 26, 2007
my total bill all inclusive, was 44,000, so if I were you I'd make the 2
hour drive, it will be worth it!! :O)
— smf0926
November 26, 2007
I HAD RNY ON 11/9, MY DR IS ABOUT AN HOUR AND A HALF EACH WAY AND THE
HOSPITAL ABOUT TWO EACH WAY. MY DR CHARGED $25,000 AND I'M STILL WAITING ON
THE ANESTHESIOGIST'S BILL, I HAVE INSURANCE THAT COVERED 80% BUT WITH ALL
MY TESTING AND ALL I'M STILL OUT ABOUT $4,000 OR SO. GOOD LUCK WITH YOUR
SURGERY AND GOD BLESS, DEBI ROBINSON
— DEBI R.
November 26, 2007
Mine is running right around $25,000.
— [Deactivated Member]
November 26, 2007
Go with the best possible Dr. doesnt matter how far away they are....in
the big scheme of things. Best quality medical is my answer to any medical
care.
— Kathy-R
November 27, 2007
Nicole, they pay 70% of "what"? 70% of billed charges or 70% of
network rates? My advice would be to check with your insurance because if
you are out of network, that 30% you pay could be significant. Also, does
your plan have an out of pocket maximum? Do you have deductible to pay out
of pocket before anything gets paid? What does your plan pay if you stay in
network? I think I would be finding these answers out pronto.
— koogy
November 27, 2007
I chose a doctor that was out of network but fortunately the hospital and
anesthesia doctors were in network. I also had to drive 2 1/2 hours but I
wanted the best care I could get. My hosital bill was 22,118.61 and my
anestheisa bill was 2,300.00. They were both paid at 90% of the approve
charge. My doctor was out of network and paid at 70%. When the doctor is
out of network that means the doctor can balance bill you for the entire
amount not covered by your insurance. When I went out of network my
deductible dand out of pocket also increased. I paid $2,000 up front and
he agreed to not balance bill me. Fortunately the doctor went to school
with my daughter and that was a lucky break for me. My surgeon's charge
included lifetime follow up care. The only thing my insurance will have to
pay will be for my lab work. Good luck on your weight loss journey.
— t_roxus
November 28, 2007
I had Lap RNY on 7-9-07. Mine was $32000 but they accepted $16000 from my
insurance. Don't give up it's worth it. I lost 84 pounds in 4 months. Good
Luck.
— John C.
Click Here to Return