Question:
Nevada Resident-If insurance denies me and I want self pay. I have figures and the

the amounts so far. My question is the amounts quoted aren't at a discount. How do I get them to drop the cost down like they do for the insurance companies? Is this too much to ask? To get a better deal just because the insurance doesn't want approve of surgery for me.Then I worry that after surgery I will have problems and can't afford the cost. Will my insurance step in and then take over because I developed problems after surgery? Does anyone know or been there? Barbara    — Barbara T. (posted on March 18, 2003)

March 18, 2003
I don't know about negotiating a better price. I would suggest you check with your insurer to see if they will cover any complications though. Mine will not cover any health problems that can be traced back to a denied procedure if the health problem occurs within one year of the denied procedure. If it occurs after the 12 month period they won't even bother to investigate how it occured and will pay for it as they would any other health problem.
   — [Deactivated Member]

March 18, 2003
Barbara, your question about what happens if self-pay patients develop complications is the reason I probably will not have the surgery if my insurance company doesn't cover it. Sure, I can get a home equity loan or dip into my 401(k) to get $25,000 to pay for a "routine" procedure. But just a few days longer in ICU, two more surgeries (for wound infection, for example), some longer-term complications, diagnostic tests and medications would wipe me out and I could STILL owe money. I shall be very interested to see what responses you get. As for your particular situation, contact your insurance company and get their policy for treatment of complications from denied procedures in writing.
   — Kasey

March 19, 2003
I've thought about this when folks discuss self-pay. I ended up in intensive care for twelve days after surgery, into a rehab center for two weeks, back into the hospital for twelve days (four in isolation) and two more surgeries, more rehab center... Et cetera. Everything was paid for at Medicare rates but the total is staggering! If I'd been self-pay I'd be in debt for the rest of my life. I find it scary, but when insurance won't pay what is the alternative? Nina in Maine.
   — [Deactivated Member]

March 19, 2003
I have to echo what people have said about complications. I had my surgery in May of 2002. I could not keep anything down from the very beginning. I was in and out of the hospital and had too many ER visits to count. I had a second surgery in July and was out of the hospital in August, then back in a week later. About 3 weeks after that I went to a step down unit for 3 more weeks, then a skilled nursing facility for a month. I didn't get home for good until October. At one point, before they had been billed for the step down unit and the skilled nursing facility, my insurance had paid out over $180,000 on my behalf. Like another poster said, if I had had to self pay, I would have had to declare bankruptcy. I would have lost my house, my car and probably all my other posessions. Most people don't go through those kind of problems. I know that I expected to bounce back and be back at work in 3 weeks or less, but it did not happen. Also, my brother and sister went to bat for me with the insurance company to get me into the step down unit when the insurance company decided I didn't need to be in the hospital. My brother contacted the case manager at my insurance company and told them I needed a place to go to so I could get back on my feet. I'm not saying you shouldn't try to go the self-pay route, but you do need to be aware that if you have any complications, you could be facing some serious financial consequences.
   — garw

March 19, 2003
I'm selfpay also. I'm having my surgeon consultation tomorrow and I'm going to talk to her about her rate of complications, though there's never any guarantees. I'm relatively low-risk since I'm a lightweight with no comorbidities that could cause complications. My insurance explicitly excludes complications, so I figure if I have any I'll have to try suing the insurance. I wonder if this has happened to anybody, given how many of us are self-pay.
   — sjwilde