My insurance (Aetna) will cover up to $10,000 lifetime for bariatric surgery. I'm getting conflicting answers from my surgeon's office about an estimate of how much I will have to pay and when.

When I first looked into the surgery, they said that after the insurance came back with its negotiated rates, the cost would probably be $15,000, so I'd be responsible for about $5000.

At my last weigh-in appointment, I asked to talk to the insurance coordinator, who was the person who gave me that info before. THIS TIME, she said that she didn't think the cost would go over $10,000. She said that in any case, at check-in, I'd have to pay my $250 deductible for a hospital stay, but that's it. Then they'll bill me for anything that goes above $10000 (that's AFTER Aetna takes the ridiculously high bill and tells them what the agreed-upon charge is).

So are there others here who have had to pay a portion, either as a percentage or because the cost goes over a coverage cap? When did you have to pay? And how bad did the cost end up being?

I just want to have a bit more of an idea so I can plan.

I had to pay the balance by my pre op appt. I owed the deductible which came to about $1100.

edited for math error

I have a deductible plan so I had to pay $1100 to meet my deductible and I also had to pay my hospital copay of $500 per day.

I have a deductible plan so I had to pay $1100 to meet my deductible and I also had to pay my hospital copay of $500 per day.

I do medical billing for a living. The best thing to do is get the medical code (CPT code) for the surgery from your surgeons office. Then call your insurance company yourself and ask what the allowed amount is for that code. You are only responsible for the "allowed" amount due. It doesn't matter if your surgeon charges $10,000 for the code, if your insurance will only allow $2300 for the code, that is what your cost is based on.

The same goes for the hosiptal stay. Not sure you can find out the CPT codes for the hospital, but you can call and try. Then again, talk to your insurance company about the allowed amount. If the surgeon and hospital have a contract with your insurance company, legally they can only base your cost off of the "allowed" amount.

Hope that helps.

I will pay at my pre op appt. I will owe about $2300.00