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Does anyone have to pay a large copay and deductible



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@@Fredbear or you could explain WTF point you are try to make. For ME the ACA sucks. My congressmen voted against it. Why should I thank them for it? Other than thank them for doing what they could to keep it from happening.

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@"kindle" I'm not sure why he's calling you blind either. No offense to Fredbear bc he usually posts helpful comments but that was kind of harsh :/

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It's political, and therefore not appropriate to this discussion; no point in going on about it further here.

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Oh I see. Gotcha. I am so incredibly thankful for my husband's insurance because I'm self-employed and would have to deal with Obamacare. I know he meant well but it's a disaster imo. Sorry, guess that's political and not helpful. I just feel really bad for those with bad insurance. It's so unfair [emoji45]

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I have Obama care under the ACA and it's covered for me. I really just think it varies. My deductible is $500 while my max is $700. I had to make sure I got a good plan. Co pays are $5 for my primary and $10 for specialist. I guess I lucked up!

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Edited by charmming

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I have to pay 10% of my total costs, up to a maximum of $3000. No doubt I will hit that $3000, and I am happy to do so. :-)

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I have medical mutual insurance through my state employer. I know quite a few employees that have went through the surgery and none of them recall paying a deductible or a rather large deductible before pre-op. I was told by my advocate that I will need to pay $1500 before my pre admission, I have been working doubles like crazy to come up with this money before surgery in July did anyone else have this issue?

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I have to pay $3500..... pay that 1500 and run!!!!!

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IF my insurance covered WLS, my max out of pocket would have been $6000. That's a $3500 deductible plus 20% of the rest until it hit $6000. But instead, I had to self pay because my insurance (which costs me $350/month) doesn't cover WLS. So I saved every penny I Could, including forgoing vacations for 2 1/2 years, went to Mexico and paid $6500.

Obamacare sucks @ss.

I know someone personally that is getting surgery through the Affordable care act! Her surgery is this month. She asked which plan covers weight loss surgery before she purchased insurance. It does pay, you just have to pick the right coverage.

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No, it doesn't always pay. There are absolutely NO individual ACA policies that cover WLS in Idaho. And before ACA I had $30 dr visit copays, my deductible was $1500 and my monthly premium was $220. So I stand by my original sentiment.
It's your state's fault. If the law in your state says bariatric surgery is considered an essential health benefit than it must be covered under your obamacare health insurance. Idaho doesn't consider it an essential health benefit. Talk to your lawmakers.

http://www.bariatric-surgery-source.com/obamacare-weight-loss-surgery.html

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The real problem is the fact that the people deciding healthcare policies that impact you and me don't have the faintest notion what they are doing. It's the most predictable thing in the world that a bunch of knucklehead politicians monkeying around with healthcare can only make things less efficient, more expensive, and overall progressively crappier. It's like asking your surgeon to run an airline, or like asking a chef to do surgery. Predictably disastrous.

That said, my insurance was great, although I suspect that had a lot to do with the surgeon's staff knowing the plans and other clearing doctors, and how to expedite the process. I had surgery 2 weeks ago and haven't even paid a copay yet. So I'm not complaining personally. I'm thankful

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It's the insurance provider who set the prices and the individual who chose the plans. That being said, my OOP will be about $2000. Which I gladly pay for a healthier me.

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If it weren't for Obamacare I would have never been able to get my surgery.....I had gastric bypass and my out of pocket was $6800 and my surgery was over $50,000 so I'm not complaining! [emoji7][emoji106]....and since I had my surgery in Feb that means everything for the rest of this year is paid in full [emoji3][emoji106]

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It can be very complicated with insurance especially if you are paying deductible or deductible plus copay.

I only had copay and it was $300.

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I will have a $200 flat copay. I chose the $0 deductible plan. All in all with the various copay's along the way for appointments related to the surgery it about $600 oop total for me.

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    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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