I see cash prices, but what about if you have insurance?

VSGandMe2011 (DisneyMomma) · November 8, 2010

I'm trying to get my finances in order so I can have VSG done in Feb/Mar 2011. I'm seeing cash prices listed, but it's as if the price if you have insurance is a BIG secret!! LOL! Maybe that isn't the case, but can anyone tell me what to expect price-wise? I'm hoping to use Dr. Nick in Dallas and I've BCBS Select PPO. Individual deductible of $630 and a family maximum at about $3500, plus an in-patient co-pay of $250. Then they cover 80% for bariatric surgeries. Also, what does that cover? I know I'll get more info from Dr. Nick's office soon, but I'm an info junkie! LOL! Thanks so much!!

Dana

Tiffykins · November 8, 2010

They'll figure in hospital fees, anesthesia fees, med fees, surgery and recovery room fees and diagnostic/testing fees plus a bunch of other stuff. My recommendation as an insurance agent, and fellow information junky, is when you get that bill for your 20%, you need to request an itemized bill, with ICD9 codes and descriptions. You would not believe the "fluff" that hospitals toss on bills and that's your 20% you have to pay. I also get a copy of my chart (every drug they gave me, every check up they performed chart), so I can compare what they gave me to what they are billing the insurance company and me for. Most insurance companies have "an agreed fee for service" with that specific surgeon and hospital, but I've seen it way too many times for patients to get gouged by hospital billing departments.

My friend had a hysterectomy, and guess what, the hospital billed her and the insurance company for a MAMMOGRAM? ? ? Yes, a mammogram during a hysterectomy, yet there was not any mammogram results to be seen in her file, she obviously didn't consent to a mammogram and didn't have one performed pre or post op. So, check your bill.

VSGandMe2011 (DisneyMomma) · November 8, 2010

Thanks, Tiff! So I won't be billed until after?? I was expecting to pay before.....please forgive me!! I've only ever had c/sections as a reference for surgery!! Then I had 9 months to pre-pay my dr and then just paid my deductible to the hospital!! I will be sure to check the bills as I recieve them and compare them to the statements from my insurance company. (I do that anyway with regular dr visits, etc.) Thanks again!!

Tiffykins · November 8, 2010

Thanks, Tiff! So I won't be billed until after?? I was expecting to pay before.....please forgive me!! I've only ever had c/sections as a reference for surgery!! Then I had 9 months to pre-pay my dr and then just paid my deductible to the hospital!! I will be sure to check the bills as I recieve them and compare them to the statements from my insurance company. (I do that anyway with regular dr visits, etc.) Thanks again!!

Hmmm, if they require you to pay upfront, then that would mean they have set fees for everything. My concern with that is, what if you have to stay an extra day, or get to go home early, or need additional meds etc etc.

Let us know how it all works out for you. The surgeon might have a set fee, but for the hospital it's kind of difficult for them to figure all that in without you actually being there.

VSGandMe2011 (DisneyMomma) · November 9, 2010

Hmmm, if they require you to pay upfront, then that would mean they have set fees for everything. My concern with that is, what if you have to stay an extra day, or get to go home early, or need additional meds etc etc.

Let us know how it all works out for you. The surgeon might have a set fee, but for the hospital it's kind of difficult for them to figure all that in without you actually being there.

Very true! I guess it would probably work similarly to having a baby....paying your dr up front but getting the hospital bill later.....ok, that ives me more info to hea into Dr. Nick'soffice with! I'm so excted! For the first time in a long time, I have hope that I won't be fat forever! YAY! I'll keep ya posted! Thanks again, Tiff!!

PlannerGirl · November 12, 2010

Another suggestion is check your policy for it's maximum out of pocket expense. For instance......I have a $250 deductible and 80/20 after that for this procedure and all that goes with it. I also have a maximum out of pocket of $2000. So.....for my surgery I can expect to pay $2250. I am keeping track of what I have paid so far (not the doc co pays for office visits, but the pre op testing at the hospital) Once I hit the $2250, I will tell the hospital to bill insurance, as I have hit my max and I don't want to wait (and perhaps argue) with the insurance company to refund me.

I am scheduled for Thursday the 18th, and I am also in Dallas. What hospital are you planning on? Perhaps I can can review it for you.

VSGandMe2011 (DisneyMomma) · November 14, 2010

Hi, Plannergirl! I'm going to use Dr. Nick....so probably Baylor at Plano. What dr are you using? Our maximum out of pocket is going up in January (new insurance year) and I can't remember what it is....somewhere around $3000, So I'm expecting to pay about $4000 since my deductible is $630. Thanks so much!!