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Does anyone have to pay a large copay and deductible

Justina0218

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Justina0218    28

Justina0218
Posted

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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Donna415    47

Donna415
Posted

I have seen quite a few policies that have $500-$1500 co pays for bariatric surgery. :( I don't have a copay but I have a $1600 deductible for the year. I ended up starting the process in March so I know I can have the surgery this year and my deductible should be met by the time I have it. It really depends on where your coworkers were at in the year or even if they have the same policy. I know some employers offer a low and high deductible option.

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KSSleeveGirl    21

KSSleeveGirl
Posted

I have a 2000 deductible to meet before my insurance will pay and then I still have a copay. I'll be paying $3000 out of pocket

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Justina0218    28

Justina0218
Posted

I have seen quite a few policies that have $500-$1500 co pays for bariatric surgery. :( I don't have a copay but I have a $1600 deductible for the year. I ended up starting the process in March so I know I can have the surgery this year and my deductible should be met by the time I have it. It really depends on where your coworkers were at in the year or even if they have the same policy. I know some employers offer a low and high deductible option.

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Thanks for responding, its just very frustrating especially. When there is no payment plans

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Fredbear    397

Fredbear
Posted

It depends on your insurance plan.

I have a high-deductible plan (HSA) with a deductible of $1,500. Once I reach the deductible (already met in January when I had to renew prescriptions), the insurance covers 90% and I pay 10%.

My out of pocket is $3,500. Once I reach $3,500 the insurance covers everything.

My surgery will be ~$17,000, of which I am anticipating I will pay nothing, since I'm pretty sure I'm going to hit my maximum out of pocket well before my surgery, which will be in November or December.

If I had met my deductible, I would be on the hook for a maximum of $1,700 (10%). If I had not met my deductible, I would be on the hook for a maximum of $3,500.

Talk to your insurance... that's what they are there for.

"When all is said and done, usually more has been said than done. "

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Kindle    8,667

Kindle
Posted

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.

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Donna415    47

Donna415
Posted

I have seen quite a few policies that have $500-$1500 co pays for bariatric surgery. :( I don't have a copay but I have a $1600 deductible for the year. I ended up starting the process in March so I know I can have the surgery this year and my deductible should be met by the time I have it. It really depends on where your coworkers were at in the year or even if they have the same policy. I know some employers offer a low and high deductible option.

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Thanks for responding, its just very frustrating especially. When there is no payment plans

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I agree 100%!

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Clarevoyant    347

Clarevoyant
Posted

My annual out of pocket max is 1250 for the year. I'll be about halfway there by the time surgery comes so will pay about 600 for surgery.

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charley27    164

charley27
Posted

I have to pay $3000

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Wolfgirl78    266

Wolfgirl78
Posted (edited)

I wish my insurance paid for WLS and all I had to pay was $1500-3000! I financed mine through my credit union. Cost me 14k

Just finished paying off that loan last month.

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Edited by Wolfgirl78

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kembfly    15

kembfly
Posted

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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Kindle    8,667

Kindle
Posted

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.

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higher    966

higher
Posted

My out of pocket maximum is $2000.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • BeanitoDiego

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