DallMike

I have Aetna PPO. The deductibles and coinsurance would have been met, but they are not crediting the surgery towards those limits. Aetna is paying 50% of billed charges and I am being stuck with the rest. Since it is insurance it seems everyone, including the surgeon, bills triple so they will be paid near the advertised cash price and then have the audacity to bill for the balance. Another funny story...my surgeon wrote an order for follow-up bloodwork and gave me the choice of letting the hospital lab downstairs do it or going to my personal doc. Well, geewhiz...since I'm already here...bang! Another $300 bill when my doc would have done it for $20 and wrote-off whatever insurance didn't pay. The surgery is lifesaving and I know everyone has to make a buck, but I feel like I bought a brand new hurricane Katrina car from Acme A1 Neighborly car lot. Just so everyone knows...I am not a hick from the sticks...I have a degree in finance, former naval officer, and business manager for 25 years. My personality borders on Andy Rooney. I am skeptical of everything and always look for the fine print. I know better than to fall for "trust me". I must be getting senile!

Still going round and round re: final bills. No help from anyone. Aetna, Dr. Nicholson's office, Baylor Regional Medical Center Plano. I have emailed a local Dallas television station and filled complaints with BBB. I don't expect anything other than you got it, you pay it. This is so wrong that insurance co-pays are more than cash price. Buyer beware. Do not accept any verbal reassurances that your insurance covers everything and not to worry. WORRY! I am smarter than that, but I guess in the weakness and fear of a life changing procedure I didn't practice my normal due diligence. If it involves money, talk directly with your insurance company only they have the right answer. Do not believe anything from doctor or hospital insurance coordinators! Their job is to sell you a new car, i.e., get your signature.

Everything was handled by the docs office and Aetna approved upfront. Everyone is in network and hospital is a center of excellence. All should be well. I'm hoping that it is paperwork and coding issues since AETNA has only been covering sleeves for a couple of months. Maybe the anger and stress will help my weight loss?

Doug, probably not the chain drugstores. Try a hospital's pharmacy or a locally own drugstore.

Yeah, I've been on slow burn for a few weeks. I'm just letting all the bills process and see what gets paid and what shows up in my mailbox. I forgot to mention...insurance is Aetna PPO and benefits are 50% coverage. Really wondering why bother with insurance.

Ok, I'm looking at hospital and anesthesia bills of $13,000 that does NOT include the surgeon's fees. This $13,000 is my share AFTER insurance. On the docs website the cash pay price that covers everything is...wait for it... $12,200. I am practicing great self-control with my grammar so I do not get banned from VSG Talk. Lots of 4 letter words with a couple of 13 letter adjectives. Everybody was in network, deductibles and co-insurance met. I will be making some phone calls over the next few days. My 6 week follow-up is next week so I may have lots to talk about.

Yes, I think mine is 3 mos too. It's just sad that I starting loving fresh spinach before my surgery and now I can't have any.:sad0: Tried some green Beans, pinto beans, and a few small bites of mashed pototoes with a hidden jalapeno without serious damage. Feel a little better. I did make one big mistake! I wish I could blame it on my wife, but it was all me...She made some homemade plain popovers. GOD they smelled up the house. I was weak and ate one.:001_tt1: I heard other sleevers talk about dumping and didn't believe it. We're not RNYers. Well...I got lightheaded, and weak and was down for the count. I had to lay down for about an hour.:svengo:Breadlovers beware!!!

So you are official? Congrats!

That's funny. I discovered fresh spinach 6 months ago. I was loading my Subway sandwich up with it. I think that's what I've been missing, not the sandwich, but the spinach. I started making my own salads with about half spinach.

Cool! So you are good to go?

I may have messed up on date estimates. It all happened fast the last month. Summar was Dr. Nick's insurance coordinator that handled everything. Aetna has to respond within 14 business days and I was calling Summar and Aetna on day 10 asking if I was approved. She is great. Everyone has been great. I was told to do 4 classes, but if only 3 great because they're kind of silly. There is a booklet though that is helpful.

Completing by the end of the year will be close. Aetna wants 4 nutrition classes spaced over 90 days. I squeaked thru at 84. Also Dr. Nick will probably taking some vacation time and others will be squeezing in to use FSAs before the end of the year. I certainly think it is doable. They are very efficient. I started my nut classes the end of Feb. I was scheduled for RNY. The nut classes are pretty basic. You can print the same info off the USDA or FDAs websites. April 12 I heard Aetna was going to approve sleeves so I told Summar to switch me. I was approved about May 3. I finished my psyche eval and last nut class May 22. They wanted to schedule surgery for June 1! I didn't think I was quite ready due to some of lifes little events and Dr. Nick was on vacation the rest of June so July 12th it was. Everything was fast compared to other stories. My biggest worry now I how much do I really owe??? Dr. Nick's office couldn't say upfront. That kind of worried me. I paid the hospital $1300 when admitted which was the balance of my remaining co-insurance since I had met my deductible for the year. Aetna's website is showing completed bills with coinsurance due of $12,800+! The hospital said once my co-insurance max was reached, the $1300, Aetna picked up the rest 100%. I haven't received any bills so who knows. I will be very upset if I end up getting bills totaling more than the cash price when my insurance has coverage. I'm enjoying the moment and keeping my fingers crossed.

Thanks Tiffykins. I'm gonna try some things this weekend. Guidelines say I'm ok, but haven't had my 6 week clearance yet. I can't wait to tear into a Wendy's salad!

Hi Stromgardgirl. I used Dr. Nick and Aetna PPO. I also went thru the 3 months nutrition classes. Also had the sleep study, and psyche eval. Feel free to ask me anything. I'm almost 6 weeks out and feeling pretty good. Congrats and good luck!

If you have existing stones or "sludge" he may recommend removal as part of your surgery. It's fairly common.