Question:
If Insurance covers the procedure, do moist Docters still require a down payment?

I have BC/BS PPO if Michigan. I have already checked and they require NO preapproval and saifd they do cover the surgery. BUT I ahve been reading some posts on the board and I am kind of worried. Do most Docters require a self pay down payment? Also in anyone's experience, does the insurance cover all of the procedure, and if not does th remainder need to be paid up front. I know it is different with most Docters....    — Ilene S. (posted on December 13, 2001)

December 13, 2001
My Dr was "out of network" so my insurance only covered 60%, with a maximum out of pocket of $5,000. plus $300. deductible. It was my experience that my Dr wanted my maximum out of pocket, up front. In my case that was $5300. Even though I have met alot of that with my pre-op testing. I could not come up with that much cash and they are taking payments. I really dread seeing the final bill. I will probably be paying for a long time to come. At this point, I am not sure it will be worth it!! I am seven weeks post-op and have only lost 42 pounds. I feel that I should be doing better.
   — [Anonymous]

December 13, 2001
Well my insurance paid 100% no down payment or anything except the phone in the room and tv.
   — bob-haller

December 13, 2001
Ilene, I have bcbs ppo, but my doc is not part of any network. I have to pay 7800 up front. I am seriously thinking about finding a doc who is in my network. Then I have to pay 40% of any other doc fees. The hospital IS part of the network, but they will bill me for the 20% remainder. Good Luck
   — Michelle P.

December 13, 2001
I think it depends on a lot of factors. Is your Doctor in or out of network? Is the hospital in or out of network? Then, what does your specific insurance plan cover? How much is your max out of pocket expenses? You should know all of these things. It is probably different for everyone. I originally had thought to go with BTC, but they were out of network for my insurance and I couldn't afford the difference ($8,000). So, I changed surgeon and hospital to ones that were within my network, so that my insurance will cover 20% of all costs up to my out of pocket max. After that, my insurance pays 100% of any reamining amount. Insurance companies generally have contracts with Doctors and hospitals that are within their networks and fees are pre-negotiated at substantially reduced amounts. Doctors and hospitals are forbidden, per their contracts, to charge the patients anymore for their services then the contracted amount. So, do a little research and find out all you can about your insurance plan and you will then have a good idea of what you will be responsible for. Good luck.
   — Susan M.

December 13, 2001
Are you sure that they don't require approval for bariatric surgery???? I'm in health care reimbursement and that doesn't sound right at all...check it out again.
   — [Anonymous]

December 14, 2001
I have CIGNA HMO, and they paid everything. The only cost I had for this surgery was my $10 copay. for my surgical consult. I have no idea if everything was "in network" or "out of network" or any of that. All I know is that they paid. :o)
   — Emily W.