I went to my initial consult, dietician, and psych evaluation on Friday and I am so bummed. My surgeon approved me for surgery and wants to correct my umbilical hernia during surgery as well as he believes I have a hiatal hernia that he would correct also. Great! He thinks I would like the bypass more but would do the sleeve if I want. Great! Dietician and psychologist think the same thing... Approved for surgery.

I ask to speak to the insurance verifier since I am self pay and that is who I was told to speak to. This is where I almost started crying. Even though they will bill my insurance for the hernia repairs, they still want me to pay either $18000 sleeve or $23000 bypass on top of what my insurance would pay and they will not let me pay the difference? Does that make sense? For example, I would have to pay anesthesia in my amount and insurance would pay anesthesia too. Has anyone ever heard of this? It seems sketchy to me or maybe I don't understand how things work? My nurse friends think that is wrong and I should just pay the difference. Does anyone have any advice? There is another doctor in the area that I feel comfortable with but I have already paid this doctors office $400.

I would like to add that in other conversations with this office I was given the impression that paying the difference was possible. I would not have started the process yet if I was told I had to have the full amount.

Edited April 13, 201511 yr by arrical8

It sounds fraudulent to charge twice for something they do once. Maybe look up your state insurance board helpline and ask if this is correct.

This is major surgery and you should have complete confidence in your surgical team. I'm not sure if you do. However, if there is any doubt $400 is a small price to pay for piece of mind.

If they do not participate with your insurance. They can charge what they want. If they have an agreement with your insurance they cannot do that. They will have an "allowable rate" with the insurance and that is all they can charge.m so you need to know if they participate with your insurance.

Edited April 14, 201511 yr by miller1109