Insurance issues

[gsusser 15]

If it matters, I am insured by the Oxford Liberty plan. I am using a very reputable NY surgeon, chief of bariatric surgery at NYU Hospital. I have some questions.

Issue 1: I want to know my out of pocket expenses. I met all the insurance requirements for sleeve surgery except for the final medical clearance. My surgeon's office scheduled me for surgery in 3 weeks. I've asked several times if they could tell me how much I was going to be responsible for. I was told it was too early to tell. I hate to be a pain in the neck and keep asking, but I'm not getting answers from the surgical coordinator. I called my insurance company. Unless I can give them very specific info (which I don't have, like the anaesthesiologist, other doctors, etc.), they can only give me general info.

Issue 2: When does the insurance company give their approval? The doctor's office said not to worry, that I am a shoe-in.

Issue 3: I'd like to know if I qualify for after-care. I live alone and have no one to help, though I can probably manage on my own. Still, I'd like to know but no one seems to be able to answer.

Issue 4: Am I being a worry wart? -)

Thank you

glenn.

[RILEYSMOM22 344]

My ins policy requires $1000 hospital co-pay plus $600 deductible. The $600 was satisfied by my pre-op testing and blood work, etc. Every insurance is different. They should be able to give you the details of your plan, which would allow you to estimate your out of pocket costs. Good luck!

[curlychic32 5]

My surgeon required me to contact my insurance at the beginning of the process and give them the diagnostic code for the sleeve. Based on that, the insurance company was able to tell me a MAX out of pocket that I would pay. This means that if all said and done, my 20% of the surgeon, anes, hospital etc went above that max, I would not be required to pay it. Mine also told me that could not tell me exactly up front what it would cost me, but they could definitely tell me the max for the procedure. Try that and see if they can tell you.

[peaceout 273]

As someone else said, not too many surgeons/hospitals will be able to give you the exact amount ahead of time. If you need extra labs, meds, or fluids, or have a complication during surgery, the amount they bill will be different. If you can't keep fluids down and have to spend an extra night in the hospital, that will be different. But many insurance companies have an out of pocket max and you should be able to find that out beforehand. I don't know anything about your specific insurance, though. My policy just has a concise chart that tells me that for any given calendar year, I won't pay more than ___ dollars.