Ok. So I have everything done. I have insurance approval. I am anxiously awaiting to hear from the surgeon what my date will be. Instead when I answer the phone, it is the insurance people from their office. They proceed to inform me that I need to make payment arrangements for the $35,000.00 that my insurance does not cover. Are you kidding me? I can get the whole thing done in Mexico for under $5,000. And that doesnt even have insurance. I have been asking costs since I started this a year ago. And I get to find out two-three weeks before my potential surgery?!?! I am devastated, deflated and enraged all at the same time.

Holy Moly!!! That's insane!!!! My doc said if we were self-pay they would work out a better price, but I'm SURE it was under $20,000...more like $12,000...something is definately wrong there... good luck on your research!

Seela - is your doctor in Ventura? I also paid a $1,500 program fee, so I thought by chance we may have the same surgeon :-)

No, chico, CA

Call your insurance provider. They will tell you exactly how much your out of pocket costs will be. The doctor cannot charge you anything more than your copay and coinsurance total. If they insist, mention your state's ins commissioner and attorney general. My total billed to ins was $22k, I paid $150, GB removal was $18k, I paid $150. Band removal $19k, I paid $150.

You might need a different Dr, but be sure to get your records first.

I smell B.S. Something is wrong with that figure, if the US cost was actually $35k, there's no way you could get it in Mexico for less than $15 - $20k. It's not THAT much of a cost difference.

My Dr never gave me a self pay price because I never asked. I was told there was special pricing for self pay.

When I got my EOB , my insurance company did pay over. $25K.

I'm guessing there is one price for the insured and another for the uninsured or underinsured

I had a similar experience with PS. Dr quoted me a price and when my insurance approved me they inflated the price so my OOP would be the same as a cash paying patient. No thanks

Something is wrong there because the whole surgery doesn't even cost 12,000 and that is with the hospital stay so someone is busting your chops I would call the insurance company not the office and ask them if it is true.

I had my surgery in December. I just recently received the bill for $35,000. My insurance paid all except $185. I live in Chicago not sure if that matters or not.

Edited March 20, 201412 yr by Cherryhair

Crazy. It would be much cheaper not to go through insurance ( sad but true). Robbery!

I paid $9600 in the US as a self-pay. So insane-- hope you get some better news than that!!!

I paid 6500 US for my surgery and 1000 for my trip to Mexico to have it done from Canada. Google Dr. Jose Castaneda Cruz in Peurto Vallarta. He was excellent and my friend just went down and got it done two weeks ago. No issues great facility!

Fishy!! Just because they charge the insurance company 50,000. Don't they usually discount that to their contracted amount?? You know darn well the insurance company wouldn't pay that much!!

My surgery total bill was $51,000 but the insurance "discount" brought it down to $26,000 and I had to pay only $300.

Isn't it great the insurance company gets 50% discount but self pay gets no discount?!

I paid $9000 for my surgery as self-pay. That was for everything. My ins didn't cover wls. Had my surgery in south Florida.

Edited March 20, 201412 yr by jamilyne 102668

wow can I empathize with you. The only thing I can say is at least you found out BEFORE you had surgery!. I was approved and had surgery (revision from lapband to sleeve) in November 13. I was hospitalized 4 days due to complications. A few weeks later I get a bill for ..... wait for it.... $132,000. So I have a major anxiety attack and call my insurance who tells me they indeed did approve the surgery but my policy only covers up to $25,000 per life time. They never told me that nor did they tell the program coordinator at the hospital I went to. Now, I have to tell you, the hospital did "reduce" my bill to $47,000. That was nice of them. When I called to make payment arrangements, the lowest they would accept per month was $800.00. That just isn't going to happen, I'm a social worker who works for a non profit agency. Scary stuff.

wow can I empathize with you. The only thing I can say is at least you found out BEFORE you had surgery!. I was approved and had surgery (revision from lapband to sleeve) in November 13. I was hospitalized 4 days due to complications. A few weeks later I get a bill for ..... wait for it.... $132,000. So I have a major anxiety attack and call my insurance who tells me they indeed did approve the surgery but my policy only covers up to $25,000 per life time. They never told me that nor did they tell the program coordinator at the hospital I went to. Now, I have to tell you, the hospital did "reduce" my bill to $47,000. That was nice of them. When I called to make payment arrangements, the lowest they would accept per month was $800.00. That just isn't going to happen, I'm a social worker who works for a non profit agency. Scary stuff.

I think the "retail price" was about $50K for hospital, surgeon etc. But insurance paid $30K after their discounts/contracts etc. I had to pay 20% of the 30K but my max out of pocket per person is 2800 so that's what it cost. Your program should charge no more than the portion they contract with insurance and THEN apply the max 15k. I doubt the other insurance companies for other patients pay the full 50K there has to be an insurance discount.