HI,

I am hopefully having my surgery in Dec. Had to move if from October. Anyway, I have a 50/50 coverage for WLS. I know that if I wanted to pay cash it would be around 19k here. My question is - What was the allowed (contracted) amount that your insurance company covered?? And, if you had a co-pay, did you have to pay that up front???

I'm still waiting to find out what the total amount I owe and it's been a week and a half since the operation. I have 20% co-insurance and a $2,500 deductible but there is a max out of pocket of $6,750. The original amount the hospital told me was over that max out of pocket number so I told them they are wrong. Once the insurance company tells what I actually owe I'll pay it. I did put $1,000 down right before the surgery as a compromise since I knew it would be more than that. They'll bill the rest once we see what the insurance company says.

I want to say my *** aenta, has a 1,000 deductible with 100% coverage after the deductible, but I'm by no means certain, no one talks about it at my hospital. But between now and my surgery I really need to figure it out if I'm going to rest easy after the surgery.

I don't know what it is about hospitals but I really don't understand the nature of the relationship between the health insurance company and the hospital. i cannot recall anything that I bought that potentially cost as much as this surgery and not actually know how much I'm going to have to pay until actual billing. I don't like the feeling that I'm walking into the surgery not knowing how much I'm going to be on the hook for when I get home. It's ridiculous!

since when is h m o a dirty word?

It depends on which insurance policy you have. I have BCBS. I have met my deductible, so the day of the surgery I have to pay $239.00. At my first visit at the surgeon office they went over what I would have to pay. All money had to be paid including copayments for pretesting before surgery is done. I would advise you to talk to your insurance company yourself. I had to sign a paper stating the price. Best of luck!