allycatt98

Nope the $240 was their estimated "negotiated" amount. The billed amount was even more. I agree... I put off trips to the doc because of the deductible. The irony is that we can have either a Flex Spending or Healthcare Savings Account. I opted for the HSA bc my employer doesn't allow us to use the FSA card for medical expenses. Those claims have to be submitted for reimbursement after the HRA account is depleted. So I opted for a HSA this year bc I can use it for medical expenses, but I only have access to what has been deducted from my paycheck. When office visits are typically over $100, that $83 per pay period doesn't go far. It's better than nothing but still painful.

It really depends on the doc and hospital. My deductible was $3000 with a $6000 MOOP. I needed a minor Gyn procedure (non-elective) and my doc required the full payment $491 at the pre-op appointment and Florida Hospital also requires payment upfront. They gave me three options: pay in full, 1/2 down and the rest split into 20 monthly payments or 10% down then 25 monthly payments (after reconciliation of the claim) thru Clear Balance, a financing program with credit score requirements. I opted for financing. During my pre-op visit my doc told me that many of her surgeries have been cancelled by the hospital because of patient's inability to pay. Not surprising considering most people have deductibles in the $1000s. So having a doc and hospital that does not require up-front payment is definitely not the norm. Side note: My Bariatric Surgeon billed me for the office consult. I'm grateful for that bc they quoted $240 and the EOB amount was only $94. ; ). I wonder what will happen in June?

I have iron deficiency anemia and will be co-managed for the surgery by a Hema/Onc. Typically I get IV Iron Dextran a couple of times per year. I've also gotten it during pregnancy, especially prior to delivery. My body does not metabolize iron well and the oral forms are merely drops in a bucket for me. The side effect I typically experience is increased bleeding. That being said, my surgeon will be extremely cautious with use of blood thinners.

DaddyMarie, Sorry, I didn't mean to imply that it wasn't a valid question. It's just usually the question is a result of misconceptions about healthcare in the States. There is a difference between the care people receive in state run (or public) facilities vs. private for-profit institutions wherever you go. So when we talk about Mexico, the Carribean or wherever, we aren't necessarily referring to the same institutions that are utilized by the residents of the area. The facilities that people are going to cater to tourists. This is how they make their money. These wouldn't necessarily be the same facilities that make the indigenous women give birth on the front lawn. There are definitely some horror stories about Mexico. But there are some facilities here that you couldn't pay me to visit. The difference is that while I wouldn't be able to afford a private facility here, I could afford one in MX. The typical MX patient is someone that either does not have coverage for their medical procedure or their insurance costs make it unattainable. The MX option allows for affordable, quality, customized healthcare. Most people wouldn't be able to afford that option here and wouldn't get the perks offered in MX. Does that make sense? Ally

GreenEye how has your post-op recovery been?

I'm sure GreenEye will have her own response, but why is there such an assumption that seeking medical care abroad is such a risk? If you do your research, you'll discover that the US does not have the best health care model. Even worse, the health care costs here are ridiculously high. So why wouldn't people seek quality affordable healthcare elsewhere? For every horror story about Mexico, there are probably ten times that for care in the States. Medical Tourism is big bucks and these providers are doing their best to attract and keep clientele.

Curvy, Was the CPAP an insurance requirement? Or was this ordered by your doc because of a condition? I have sleep apnea that has been untreated for years I'm talking 10 plus years. Surgeon required new sleep study which confirmed I have obstructive sleep apnea. I was required to sleep on it for 3 weeks prior to my surgery or no surgery.Plus having the sleep apnea helps with the WLS approval as well because with most insurance companies sleep apnea is a comorbidity. Well I know u know that already being a utilization review nursing professional lol. Had I known earlier I would have worried u sick everyday asking u " do u think they r going to approve me" lmbo. They came back with an approval in 3 days so that was awesome.Well with UHC it's easy, give them what they want and they'll go away..... It's a helluva lot more difficult with some of the smaller plans. I'm so grateful to have UHC. But that whole Bariatriic Resources program was a pain in the a$$. I'm happy you got your gear. Are you going to try to get your Protein drinks covered?Girl we had Aetna first sbd they were hell!! Switched to UHC was much better. They don't cover the protein shakes.I see posts on and off about people getting the shakes covered..... But I'm not sure if they're prescription shakes processed as a DME benefit or what. I'm gonna do some more reading.

Curvy, Was the CPAP an insurance requirement? Or was this ordered by your doc because of a condition? I have sleep apnea that has been untreated for years I'm talking 10 plus years. Surgeon required new sleep study which confirmed I have obstructive sleep apnea. I was required to sleep on it for 3 weeks prior to my surgery or no surgery.Plus having the sleep apnea helps with the WLS approval as well because with most insurance companies sleep apnea is a comorbidity. Well I know u know that already being a utilization review nursing professional lol. Had I known earlier I would have worried u sick everyday asking u " do u think they r going to approve me" lmbo. They came back with an approval in 3 days so that was awesome.Well with UHC it's easy, give them what they want and they'll go away..... It's a helluva lot more difficult with some of the smaller plans. I'm so grateful to have UHC. But that whole Bariatriic Resources program was a pain in the a$$. I'm happy you got your gear. Are you going to try to get your Protein drinks covered?

Curvy, Was the CPAP an insurance requirement? Or was this ordered by your doc because of a condition?

Hey Curvy, When's your surgery date? Hey girl! Remember they changed me to April 14th and it's just 15 days away.Ah you're in the homeward stretch! Well I'll be reading your posts with a rather envious shade of green until July. Go get 'em!Hahahahaha...girl liquid diet starts tomorrow dear Lord help me lol.You will be fine! I can't wait to read about your diet.So far Protein shake, crystal light, and Water. Can't wait for a break in this meeting to go make me a shake I'm feeling the rumbles lol.Did you pick out your own shake or are you using a physician supplied one?

Hey Curvy, When's your surgery date? Hey girl! Remember they changed me to April 14th and it's just 15 days away.Ah you're in the homeward stretch! Well I'll be reading your posts with a rather envious shade of green until July. Go get 'em!Hahahahaha...girl liquid diet starts tomorrow dear Lord help me lol.You will be fine! I can't wait to read about your diet.

Hi Lex! I didn't even know this board was here! I'm in the Tampa Bay Area. My surgery date isn't until July. I'm definitely interested in documenting my journey.

Hey Curvy, When's your surgery date? Hey girl! Remember they changed me to April 14th and it's just 15 days away.Ah you're in the homeward stretch! Well I'll be reading your posts with a rather envious shade of green until July. Go get 'em!

That's specifically nicotine not marijuana I disagree. The issue here wasn't the choice of product, it was the failure to disclose smoking (be it nicotine or marijuana) to the physician. I don't remember reading about edibles, so I'm assuming the product was inhaled. Marijuana affects the CNS, so there are definite surgical risks that the physician needs to be aware of in order to best care for their patient. My point wasn't to imply that the surgery couldn't occur, but that failure to disclose pertinent health information could lead to unintended consequences. Glad to read that you and your doc were able to agree on a treatment plan so you could proceed with your sleeve.

Hey Curvy, When's your surgery date?

Mine isn't scheduled yet, but it will probably be sometime mid-July. I finish my last NUT visit at the end of June and have business travel commitments the first week of July. I'm so excited to be at the half-way mark finally.

Girlie, I'm so happy that you made it through that ordeal and are hopefully home now. I just wanted to point out that there are risks with every surgery -- even those considered routine. I've had four Cesarean sections and almost didn't make it through the last. Like you I have an unnamed bleeding disorder. I'd been given weekly IV infusions of Venofer for four weeks prior to my Cesarean as a preventative measure and I still bled out in the OR. This was a top ranked women's hospital, the same one used for my previous deliveries. So my point is situations like this can happen anywhere when your medical team doesn't pay heed to the information you provide. What happened to you could occur to any of us regardless of our location. The fact that you were in MX when it happened complicated an already serious situation. I appreciate you posting this. I'd originally considered surgery in MX with Lopez/Osuna, but decided against it because of my bleeding disorder, gallstones and their per diem fees. The last thing you needed was someone demanding money when you required life saving treatment. This is definitely a cautionary tale. What would've happened if you didn't have resources to cover the extra $2000?

I think you look great and I'm hayting you right now! I still have three more NUT sessions to go. Personally I think you look good in both pics, but I can definitely see the results of your five weeks in the "after" pic. Ally

Always!! I stick to my guns and I explain again and again they don't know my situation. They don't know what other care my kids are getting or my husband. They don't know the cost of my prescriptions. Bottom line these insurance coordinators are great but they're not holding a crystal ball over everyone else's charges and how fast the insurance company gets a claim and pays a claim for someone else. You refuse enough times up front and pay on time when you get the bill, they'll respect your no. This is so true. UHC has online estimates for Gastric Bypass and Lap Bands, but no sleeve. I requested a pre-determination so we're all on the same page. I've still got summer vacation to pay for

Unless you're doing it to establish a co-morbidity, it's usually just done to fulfill insurance requirements. Most insurance plans moved away from all of the clearances and sleep study requirements. But there are some that still require them. Just like some plans require PCP clearance or letters of medical necessity. Mine doesn't, but just about all the docs I considered wanted me to get it. I guess they've just adopted some insurance requirements into their practice to make sure all the bases are covered. I'm not required to do one.

Kindred spirits! I did mother/baby before moving over to managed care. I'm wondering about the fiber though..... It can be a double-edged sword. Given the sizing issues are you sure it won't produce the same bulk you're trying to avoid? I avoid it like the plague. Now it sounds gross, but have you ever given a milk and molasses enema? We used to do this for hospice patients. My issues resolved in a week, but it was a very painful result. I'm not sure I would keep pushing the laxatives, "bulkiness" is an issue.

CPrince, I haven't been sleeved yet, but I've had four Cesarean sections (and I'm a nurse) so I feel like I'm somewhat qualified to comment. First up, you might want to slow down on the laxatives. Here's why, if you're impacted, the laxatives are going to make you miserable because they will promote peristalsis and you will have the force of that hard stool "ehem" trying to exit your rectum. I was miserable. I'd taken all the stuff people recommend and could feel the force of it, but it was too hard to get out. I had to sleep on my side and couldn't bear to even sit. I finally ended up bearing down (because I couldn't take it anymore) and ripping my rectum. Not fun. So focus on the stool softeners. I know they are not immediate. Then try to position yourself to promote the exit of the stool. Consider buying a Squatty Potty. Google toilet positions for constipation. The toilet is really not you're friend when you're impacted. I'm hoping things get better for you. It took me about a week. Ally

Yes, as a member you have the right to file an appeal. You can also give your physician the right to file an appeal on your behalf. But positive thinking! If you are concerned about the approval process, keep track of your documentation throughout the process. Know the requirements and read up on their review process. If there is a specific format they want for the NUT counseling and psych visit make sure that's what they get. Every review process is different. Some plans will contact the doc for the missing information. Others will just issue a denial. The plan I worked for had millions of members so their volume was ridiculous and it often did take the full 14 days for review. If we were at the TAT deadline, then typically a denial was issued for missing information. But... The doc still had the ability to request a peer-to-peer review with the health plan's doc to discuss the request.

Do you have an out-of-pocket max? If so did they ask for that at any point. I'm asking b/c my deductible is $500 which I've just about met and I have an o-o-p max of $2300. I'm thinking the hospital may ask me for that also. I know they all are differs just wondering what your experience was. I'm still waiting on my approval and don't want any surprises! Lol Keedy,The hospital should not ask you for your entire MOOP. What is your co-insurance after deductible? For most people it's usually 20-30%. Your payment/deposit to the hospital should be based upon an estimate of your co-insurance responsibility of the "negotiated" fees. Your insurance company should be able to provide you an estimate of the negotiated amount. Then figure out your responsibility and try to haggle a deposit/payment with the hospital. Additionally, I would take in any proof of payment to the physician. Because your MOOP at the time may not be reflective of payments.

I am not ignorant of my insurance. Completely the opposite. You must be lucky and not have a large out of pocket. I know how much everything costs and what I will pay at every moment. And that is why I will never pay a penny, nickel or dime up front. If I am cash pay then that's different. But with deductibles it's all about who gets the bill in there first. I am not willing to give a hospital or doc several thousand when the anesthesia and radiology will get in first. I will owe them that money. So I pay when I get an EOB or a bill and never up front. That happened to me once 5 years ago. I was $4500 away from the deductible so i paid $1000 to the hospital up front with promise to pay $1000 a month after. Well surprise I got was anesthesia doc charged more than hospital stay was allowed. No joke. The anesthesia charges were $18.000. And the hospital allowed from insurance was $4800. Anesthesia was out of network so they got paid and wanted my deductible, and guess who got his bill in first? Needless to say hospital got fully paid and took me 90 days to get a refund from them. Anesthesia took a lot longer to come to an agreement and a formal filing of complaint with the medical board for excessive fees. I paid them nothing. They put it on my credit report I filed another complaint and lawsuit. I understand your methodology, but how often are you able to get away with it? I don't want to, but I often get stuck paying the "estimated" fee and getting refunded later. I'm definitely EOB happy and glad to see that I'm not the only one. My surgeon's office initially told me that my consult would be $240, but later decided to just bill me once they receive the pre-determination estimate from insurance. Just got my EOB and my responsibility is only $94. ; )