insurance not paying

[sleeveme4152 16]

My insurance denied me, the barix Clinic said they hit a brick wall with my insurance, BCBS PA PPO. My husband said we will self pay, but the Clinic is $25,500. I live in NE PA and was wondering if anyone else is self pay and where they went that is cheaper. my husband said go to the clinic. his analagy is do you want a mechanic charging you 10.00 an hour that doesn't know what to do, or one that charges 100.00 that is awesome at what they do? please help. lead me in the right direction. thanks

[Jersrose43 837]

Why were you rejected? ContrAct exclusion? Or can you appeal?

Many on here got to Mexico as self pay. There are also a couple threads about competitive pricing in houston -- less than 10K

You can also research private insurance plans through obamacare and pick one of those up temporarily and see if it will cover all the costs.

Self pay can be dangerous. You could go without insurance for complications and future needed surgeries may not be covered.

[Pepper123 320]

Sorry u were denied….but why did the insurance deny you?…there are cheaper doctors with excellent reviews…many people go to Mexico so u should research that..also personal loans are available…good luck!!!

[SherB 220]

Insurance companies can no longer deny you service for future needed services or pre-existing conditions. Now a doctor may refuse to assist you if you have had service outside of the US but follow up or emergency cannot be denied.

[AvaFern 3,516]

I'm sorry you were denied. I was self-pay because I didn't want my insurance to raise my rates and because I wasn't patient enough to wait through the process. I decided to have a consult with the doctor and two weeks later I was in surgery. The doctor I used is in FL and much as I thought he was kind of a jerk of a person, he is an excellent surgeon. I never had a single issue, my scars healed perfectly, and I am complication free. The total cost for my surgery paid in cash was 18K. They also have a financing option. I would say perhaps try calling different areas, especially if you are willing to travel. Also, a lot of people have had great experiences with surgeons in Mexico for about 1/3 the price of what I paid. Something to consider...

[Beth Pets 36]

I like your husband. He sounds like a nice guy and a smart fella!

[alamergrl 8]

my surgeon in kansas city charges 11999 for a sleeve or lapband cash pay.........the practice is a center of excellence and performed the most in kc last year

[LisaNLasVegas 91]

Plan a trip to Las Vegas! My surgeon is awesome and does travel packages. Check out the website Blossom Bariatrics with Dr. Umbach. You can search them both on You Tube and see some videos, as well. I think his charge is close to 11K for the whole procedure done in his surgical center. My insurance paid, so I am not sure, but you will love the practice! Good Luck!

[LisaNLasVegas 91]

PS - going to Mexico is risky. I had my lap band in Mexico in 2003. When I started having complications this year, one practice wouldn't even see me without a $5K "take over" fee since I had my surgery out of the US. I don't regret it, but there are definitely roadblocks in the future.

[1959JimmyJames 61]

I really believe that some insurance companies deny first and wait for an appeal. Patients will get desperate, and seek out an alternative. The insurance company saves money by not paying a claim that would be approved on appeal. I had to go through an appeal. The clinic and my doctor handled it and it was approved but the process took a few months and was stressful. They had all of the correct information the first time around but they denied it, saying, "I didn't have any co-morbidities". The appeals panel had a conference call with my doctor and he explained everything to them and they approved the procedure. This should have been approved when the request was first submitted but it was rubber stamped denied. If you feel desperate, then they have you. If you haven't already, then you should give the appeals process a chance. Those other surgical alternatives will still be there. If you can afford it then I would take your husbands advice and do it there. Your doctor is there, your hospital is there, your home is there, and your family is there. Although, a nice medical vacation to Las Vegas, could be fun. Good luck.

[woo woo 872]

Prices in Dallas are very low and the surgeons are very well-regarded. Look into Dr. Nicholson or Dr. Kim and there are probably a couple others as well in Dallas.

That being said, if your husband is on board with paying for your local doc, I might just go with that for the convenience.

Otherwise Dallas, or also FL and LA have pricing that is much lower than the self-pay prices up north. I have also heard good things about Dr. Umbach in Las Vegas as well.

[FedUpwithBeingFat 28]

@@sleeveme4152

I am self pay in Mississippi. 4 years ago the price was 29,000. I put off the surgery due to the price. The costs of B. Surgery has gone WAY DOWN!!!!! I'm hoping for a September Surgery Date and got the self-pay information at the initial group meeting in July. It is 12,500. There are 2 surgeons in this group. One has been doing these procedures for years and has an IMPECCABLE reputation. He is nearing retirement age so 2 years ago he brought in a younger surgeon. This new surgeon did his residency at Cleveland Clinic. (Highly respected for Weight Loss Surgery Research, etc.) I think you could research places that have more reasonable rates yet still have EXPERT and EXPERIENCED surgeons. Good luck with your search!

[Pepper123 320]

so true @1959Jimmy…i was denied in july 2014 and resubmitted the application on in july 17th 2014…it did not take very long for them to approve it 8/6 so i was very happy..it pays not to be desperate thats what the insurance companies want for us to give up...

[Jersrose43 837]

Insurance companies can no longer deny you service for future needed services or pre-existing conditions. Now a doctor may refuse to assist you if you have had service outside of the US but follow up or emergency cannot be denied.

Sherb the denial from insurance company won't be due to pre existing conditions but rather because services rendered were not authorized under plan in first place and therefore all future care is also denied relating to those services.

The only way around that is to get a new insurance company, which in many cases means a new job.

Have seen this rejection on this site several times already. I think it's bogus bs. But I am sure it's real. Obamacare ties their pre existing hands. But that have large internal legal counsel for a reason.

[chelseahall91 1]

My insurance denied me, the barix Clinic said they hit a brick wall with my insurance, BCBS PA PPO. My husband said we will self pay, but the Clinic is $25,500. I live in NE PA and was wondering if anyone else is self pay and where they went that is cheaper. my husband said go to the clinic. his analagy is do you want a mechanic charging you 10.00 an hour that doesn't know what to do, or one that charges 100.00 that is awesome at what they do? please help. lead me in the right direction. thanks

Bcbs of SC denied me and my doctor told me to appeal too. They said If my insurance didn't fall through that i have to pay 25,000 $ up front and they do not accept payment plans. So we'll see what happens. The insurance company doesn't know why I'm specifically needing my surgery, so maybe it'll help if they know. But who knows. I'm so upset right now.