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I have a crazy question for you!

SherriWittler

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SherriWittler    1

SherriWittler
Posted

My friend and I was talking about the cost of the LapBand surgery ...... I was self pay and I was telling her I bet the cost that is billed to the insurance is a LOT higher than the self pay price.

So, would any of you be willing to tell me what the total was that was billed to your insurance company for EVERYTHING (doctor and hospital)?

Thanks,

Sherri

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Jerseytammy    0

Jerseytammy
Posted

Sherri

If I remember right , it was some where in the neighborhood of $22,000. I have excellent insurance so out of pocket todate is around $200.00

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gentlespirit    1

gentlespirit
Posted

My total was about $17,000 of which I am paying off my $2,500 max out of pocket. (Unfortunately I had my surgery in Jan. so was starting over with the out-of pocket)

Emily

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JLPAGE    0

JLPAGE
Posted

If I remember right the insurance was billed about 25,000 - which they only paid % of due to the hospital and surgeon I used are in-network. My surgeon billed the insurance 8000 and was paid 2300 since he was in network. I ended up with 3500 plus another 1000 out of pocket due to above area charge on out of network assistant and sleep study. Hey 4500 for a healthier me is an awesome deal!!!

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piercedqt78    658

piercedqt78
Posted

$33,000 but I had to spend the night and that included my barium swallow the next day. The insurance paid around $17,000 total, my out of pocket was co-pays for the pre-op visits (x3) and the follow-up (x1) at $15 each. I don't pay for fills as they are done at the hospital and it is billed as diagnostic, but I pay a co-pay for the office visit that decides I need the fill. ~Mandy

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JMO    0

JMO
Posted

I was told by Dr Woodman in TN that they bill the ins. (United Healthcare) a total of 6000.00 for the surgery. That does not include after care...

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JJB    2

JJB
Posted

I have United Health Care and they were billes 22,000. I had to pay 3,700 out of pocket. I had to stay over night also.

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bandayed    0

bandayed
Posted

My insurance Co was billed $27,000 for everything including 2 nights in the hospital. Not sure what they say for self pay, but I think you're right, it's a different amount. I've noticed on my ins statements that the Dr usually bills one amount to the ins co then there is something called and "agreement amount" that is deducted which, by the way, is usually more than HALF the original amount....then insurance pays the rest. I think that private care is actually MORE than what the insurance Co pays. I think they look at it as a volume discount kinda thing and give the insurance co a break.....hmmmm seems awfully close to payola to me!!!!

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Wheetsin    714

Wheetsin
Posted

Here's a pasting directly from my insurance company's online claims center, with visits to my PCP removed. I have no clue what the $4000 is for, it has just shown up recently. Need to call my carrier and ask, because the 29k would have covered everything, I'd think... and I don't even know who "P KRAMER" is... "R SABAPATHY" was the psychologist in the bariatric program, "S HOEHN" was my surgeon and SHAWNEE MISSION was the hospital I had my surgery at. I'm also not sure why the 19k shows twice, I assume it's a mistake...

<TABLE class=claimsummarytable cellSpacing=0 cellPadding=2 width="100%" border=0><TBODY><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Date</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Phys/Fac</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Status</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Total Charge</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Patient Responsiblilty</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>px_trans.gif<NOSCRIPT> </NOSCRIPT><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT></TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>03/01/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Midwest Anesthesia </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$1347.98 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$20.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>px_trans.gif</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>03/01/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Alliance Radiology </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$35.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>03/01/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>S Hoehn </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$4000.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00 </TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>03/01/2006- 03/31/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Shawnee Mission </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$23.50 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/24/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>P Kramer </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$18.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/23/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Alliance Radiology </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$42.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/23/2006- 03/01/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Shawnee Mission </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$29076.25 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/23/2006- 03/01/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Shawnee Mission </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$29076.25 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/21/2006- 02/28/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Midwest Anesthesia </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$330.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/21/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>R Sabapathy </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$165.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00 </TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/21/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Midwest Anesthesia </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$165.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00 </TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/09/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Midwest Anesthesia </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$200.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00 </TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>

</TD></TR><TR><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>02/03/2006</TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>Shawnee Mission </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>processed </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$116.00 </TD><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle>$0.00</TD><!-- This if condition is added by Syed for myuhc00000094 on 12/24/03--><!-- This if condition modified by Mani for myuhc00000094 on 01/20/04--><!-- For issue #748 --><TD class=body style="BORDER-TOP: #c2bcb3 1px solid" align=middle><!-- For issue #748 --><SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>px_trans.gif<NOSCRIPT> </NOSCRIPT><!--Modifications are over -->

<SCRIPT language=javascript>document.write('px_trans.gif');</SCRIPT>px_trans.gif

</TD></TR></TBODY></TABLE>

Grand total charged so far: $35518.73

Out of pocket so far: $20.00

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LindaV    0

LindaV
Posted

Hi,

The contracted rate for Lap Band surgery for the surgeon that my insurance company will pay is $3,800. My doctor's fee for self-pay is $8,000.

I think contracted insurance rates are usually 40-60% below regular rates.

It's too bad hospitals/doctors don't charge a flat rate that is reasonable. Insurance costs would go down and if you were not able to get insurance, medical procedures would be more affordable.

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ReneBean    3

ReneBean
Posted

I think my insurance company paid in the viscinity of $40k. I was pretty surprised - because the Cash price was $15k - and that would have included a full year of fills and aftercare...

I'm not asking any questions, though. I never use my insurance for anything else... and I didn't have $15k.

:]

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Wheetsin    714

Wheetsin
Posted

Oh I should add - my numbers don't reflect the plan's negotiated rates. They're way lower. Here's a piece pasted that shows "submitted" vs. "actual" payout.

<TABLE class=claimstablewithgrid cellSpacing=0 cellPadding=3 width=748 border=0><TBODY><TR><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Individual Service<SCRIPT language=javascript>document.write('?');</SCRIPT></TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Total Charge<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Network Discount<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Allowed Amount<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Patient Copay<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Deductible<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Not Covered<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>% Paid by Plan<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell id=pp vAlign=bottom bgColor=#ffffff>Paid by Plan<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH><TH class=claimstablewithgridcell vAlign=bottom bgColor=#ffffff>Remark Code<SCRIPT language=javascript>document.write('?');</SCRIPT> </TH></TR><TR><TD class=claimstablewithgridcell align=middle>Op Misc. Services</TD><TD class=claimstablewithgridcell align=middle>$29076.25</TD><TD class=claimstablewithgridcell align=middle>$27402.25</TD><TD class=claimstablewithgridcell align=middle>$1674.00</TD><TD class=claimstablewithgridcell align=middle>$ 0.00</TD><TD class=claimstablewithgridcell align=middle>$ 0.00</TD><TD class=claimstablewithgridcell align=middle>$0.00</TD><TD class=claimstablewithgridcell align=middle>100%</TD><TD class=claimstablewithgridcell align=middle>$1674.00</TD><!--remarkcode start---><TD class=claimstablewithgridcell align=middle>D2 </TD></TR></TBODY></TABLE>

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SherriWittler    1

SherriWittler
Posted

Oh I should add - my numbers don't reflect the plan's negotiated rates. They're way lower. Here's a piece pasted that shows "submitted" vs. "actual" payout.

Wheetson -

Are you saying your insurance then only had to pay $1674.00?!

Sherri

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