So very irritating!

[Richardson111508 0]

I recently started working with True Results of Dallas to start the gastric sleeve process. They took all of my info and scheduled my first appointment. 2 days in, I find out that they are out of network with my insurance. True Results went out the window.

I then contacted my insurance company and asked for a bariatric surgeon/facility in my area that was in network. They referred me to the Baylor University Bariatric center, whom I contacted to begin the process. They had me complete a super long packet of information which I promptly turned in. By the end of the day, they called me and said "CONGRATULATIONS, you are pre-approved!" and proceeded to outline the requirements that I would have to comply with (6 months of classes, a psych eval, enrollment in a bariatric services program and provide 5 years of medical records).

I have a $3000 deductible. Once that is met, I pay 20% copay up to a max of $8000 out of pocket. Naturally, my first question was "What is it going to cost me?" Her answer was " If you had surgery today, it would be $2458 and that will probably go down as you continue doctor visits etc over the next 6 months. That didn't sound right, so I asked for a detailed explanation which she was unable to provide. I asked what amount will I have to pay 20% of? She didn't know but promised me it would be $2458 or less total out of pocket.

Today, I called my insurance to enroll in the bariatric services program (which Baylor said I must join) just to find out that I didn't need to do that. In fact, they told me I couldn't enroll if I wanted to because it wasn't a requirement for me to receive bariatric benefits.

At this point, I'm wondering if Baylor knows what the heck they are talking about, so I call them back and ask to speak to a billing supervisor to get a second opinion on the $2458 figure that I had been quoted. This lady tells me that the surgery will "probably cost $44,000 which doesn't include anesthesia, the classes, psych, or physician and physician assistant fees." I explain to the lady that I had been quoted $2458, but something didn't sound right because 20% of $44,000 is $8800. Her reply infuriated me. "Sir, there is no way for me to even estimate what this is going to cost you out of pocket. You just have to go through with the procedure and wait on a bill to find out. We can't even guarantee that the $44,000 number is accurate because it might only be like $34,000. You should plan on hitting your max out of pocket of $8,000, but we can't give you an estimate".

I can't afford that any way you slice it. Aside from that, how on earth can someone commit to something not knowing what it will cost?. That's like buying a car and the dealer saying just go ahead and take it with you-we'll tell you what you owe us in a few months. On top of all that, I find out today that if I don't use my insurance, the price is $10,500. I'm saving a whopping $2500 by having insurance. Sounds to me like they are raping the insurance companies.

Has anyone else run into this kind of BS? I can afford about $3000 to $4000, but $8K is out of the question. I'm not interested in financing or monthly payments. Should I just forget the whole thing and learn to be fat and happy?

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[JamieLogical 8,684]

My insurance wouldn't cover my WLS at all. I didn't have a documented 5 year history of a BMI over 40, because I had naively attempted to lose weight on my own a few years earlier, dropped 90 pound, and had JUST crept back up over a 40 BMI when I began pursuing surgery. I felt like they were punishing me for at least having TRIED to lose weight without surgery. My options were self-pay or to stay fat another 4-5 years to qualify. I decided to self-pay in Mexico and it worked out great! I didn't have to jump through all the hoops. I was able to schedule the surgery on my own time-line. I got to have a world renowned surgeon instead of whatever local surgeon was in network. You might consider that route if it's looking like your insurance isn't going to work for you. My specific surgeon was out of the price range you said you could afford right now, but you could either save up a little or consider other surgeons. I know BariatricPal is now affiliated with several surgeons in Mexico and offer decent pricing to BariatricPal members.

[FreeTheSkinny66 9]

JamieLogical - were you at all concerned about potential complications and insurance not covering that when you decided to do Self Pay?

I am still pretty early on in the process and have primary and secondary insurance, neither of which exclude bariatric coverage), but I am still very concerned about getting approved since my BMI in < 40 and I do not have any of the "standard" co-morbidities". So I have started to toy with the self pay option. BUT....the potential for complications and those costs coming out of my pocket have almost scared me out of that idea.

Just curious as to whether this was a concern for you.

[JamieLogical 8,684]

@@FreeTheSkinny66 I called my insurance company to make sure that if anything went terribly wrong once I was back in the US (infection or leak or whatever) I would be able to go to the ER and they said yes. As for concerns about the level of care I'd receive in Mexico, I wasn't worried at all. I had actually been to Mexico for plastic surgery before and knew that excellent care was offered there. I also did a LOT of research into my surgeons and the surgical centers they practiced out of ahead of time (for both my plastics and my sleeve). I also discussed it extensively with my PCP ahead of time and arranged for her to handle my follow-up blood work and such (all of which was covered by my insurance).

[FreeTheSkinny66 9]

That is good to know - I had heard stories of some companies excluding coverage for any complications stemming from bariatric surgery! Thanks!

[Richardson111508 0]

I think I'll stick to a surgeon in the US.

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[Jodi C 14]

I have Blue Shield of California. An HMO plan non the less that covered everything except $25 co pay visits for appointments and $200 for surgery co pay. I paid less than $300. I started with my PCP who put a referral in to see an in network doctor for my evaluation. And from there, I needed authorization to see the psychologist, nutritionist, and sleep study doc. But once authorizations were approved it was just my co pay. Also, I should note that I had called my insurance before I did anything and knew exactly what was needed to be approved.

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[missvee 28]

If you have an in network deductible of $3000 you may or may not meet that during the 6 months of visits. Every visit that is still under deductible you are going to pay ONLY the allowed amount for the visit which the office should have a fee schedule for your insurance. Once the deductible is met you pay 20% of the allowed amount so if they bill $350 for a visit after the deductible is met and insurance only allows $100 you pay 20% of the $100 not the $350. If they even remotely try to do otherwise contact your insurance company and let them know because they are double billing and defaulting on the contract that they went into with your insurance company

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[Sarah 82 9]

I worked with True Results out of Dallas also and had surgery at Baylor. I also work with insurance and telling patients how much they'll owe for procedures as part of my job. I ended up having to be the one to explain to Baylor what my bariatric benefits are. They had them all messed up. I can tell you that $8000 is the most you'll pay out of pocket for ALL medical services until your plan rolls over. If you want, I can look into it for you from a provider's viewpoint. If you'll send me an email with your full name, DOB, and insurance info I'll see what they tell me about it. I have access to a few more resources than you probably do. My work email is Sarah.seelbach@uthct.edu

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[brandici 0]

My insurance wouldn't cover my WLS at all. I didn't have a documented 5 year history of a BMI over 40, because I had naively attempted to lose weight on my own a few years earlier, dropped 90 pound, and had JUST crept back up over a 40 BMI when I began pursuing surgery. I felt like they were punishing me for at least having TRIED to lose weight without surgery. My options were self-pay or to stay fat another 4-5 years to qualify. I decided to self-pay in Mexico and it worked out great! I didn't have to jump through all the hoops. I was able to schedule the surgery on my own time-line. I got to have a world renowned surgeon instead of whatever local surgeon was in network. You might consider that route if it's looking like your insurance isn't going to work for you. My specific surgeon was out of the price range you said you could afford right now, but you could either save up a little or consider other surgeons. I know BariatricPal is now affiliated with several surgeons in Mexico and offer decent pricing to BariatricPal members.

What's your surgeon's name?

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[JamieLogical 8,684]

My insurance wouldn't cover my WLS at all. I didn't have a documented 5 year history of a BMI over 40, because I had naively attempted to lose weight on my own a few years earlier, dropped 90 pound, and had JUST crept back up over a 40 BMI when I began pursuing surgery. I felt like they were punishing me for at least having TRIED to lose weight without surgery. My options were self-pay or to stay fat another 4-5 years to qualify. I decided to self-pay in Mexico and it worked out great! I didn't have to jump through all the hoops. I was able to schedule the surgery on my own time-line. I got to have a world renowned surgeon instead of whatever local surgeon was in network. You might consider that route if it's looking like your insurance isn't going to work for you. My specific surgeon was out of the price range you said you could afford right now, but you could either save up a little or consider other surgeons. I know BariatricPal is now affiliated with several surgeons in Mexico and offer decent pricing to BariatricPal members.

What's your surgeon's name?

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Ariel Ortiz of Obesity Control Center

[IMissVegas 23]

I'm supposed to go to True Results to get my lapband unfilled. I wonder what that will cost. I looked up the cost of the EGD that is scheduled in a week and it's $800+ after insurance! If they want it all up front, I'm screwed.

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[IMissVegas 23]

I have a dumb question. Once I hit my OoP for the year, do I still pay copays?

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