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Kaiser Questions

So I started the process today, met with intake. They had me call the Finance Counselors. I had already used the estimator on KP.org, so I was expecting 4 to 5k out of pocket. The counselor says no, it's 14k. They break it up into 36 payments of 338, which is after paying 2k just to schedule the surgery. Is that normal?

I mean that's a car payment...I was okay with this when the estimator said the 4-5k. I'm not so sure I can put this financial burden on my family, even for the sake of my health.

Is anyone aware of options I can look into? I'm in Colorado if that makes a difference.

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  • Ok here is an update. As is of 2017 all Kaiser Colorado plans now have a state requirement that bariatric surgery deemed as medically necessary must apply to the deductible and out of pocket max. Ther

  • Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the

  • Might check the other hospitals to see if it is cheaper. Sent from my SM-G920T using the BariatricPal App

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I'm with Kaiser in Northern California and the cost is covered with a $250.00 co-pay.

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Wow. can location seriously be that big a difference? That's crazy to think in one state it's 250 copay and in another state it's 14,000...

Southern California here and I'm also $250

Theirs is co-pay.. They have insurance.. Do you have insurance @@Avarine or are you paying for the surgery totally out of pocket?

Munky

Oooh silly me LoL Kaiser question means your insurance.. Excuse me.. Sorry.. And Holy sh!t that's crazy for a "co-pay" ????

Munky

  • Author

Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the process. And then they turn around and say 50%. is all they cover and the entire bill is $28,000; so my share would be $14,000, and that's just for the surgery. I still have deductibles for speciality appointments with the doctor, mental health and the classes leading up to the surgery.

It just seems crazy...and I just need to research and see if there is something I am missing.

Well, you can look into going to Mexico. It is a lot cheaper. But I wouldn't suggest BELITE, they send their patients to JUAREZ. The surgeon is amazing but the Hospital really isn't anywhere close to the USA. But I have heard that in Tijuana it is much better. My hubby had his SLEEVE done in Juarez and like I said our experience wasn't too good with the practice of their hospital. It was called STAR MEDICAL or just MED I don't totally remember.

What hospital are you using? Can you use Denver health, Rose, St Joe?

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WOW, I know everyone's insurance is different however if my insurance didn't cover my surgery it would be 12500 out of pocket and that would cover everything all appointments also they require half down and then we'll set up the remaining 6000 divid it into payments.. 4 years ago when I had the Lap-Band it came back that my insurance didnt covering the surgery that I wanted which was the sleeve they Said it would be 17000 cash so I ended up paying $9,000 and went with the Lap-Band I wish that I would have done more research and looked at other facilities however I was vulnerable and was desperate for anything now I have to deal with this thing until I can get it out and have the sleeve done...in which I hope is soon!!!!!!

Sent from my SM-N910V using the BariatricPal App

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What hospital are you using? Can you use Denver health, Rose, St Joe?

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It's through St. Jospeh's

Might check the other hospitals to see if it is cheaper.

Sent from my SM-G920T using the BariatricPal App

I am on a platinum plan I purchased through the state exchange (Maryland). My premium (which I take no assistance for) is about $320 a month. I got the higher-end plan because of my health issues. My copay for the surgery was $350 (would have been $250 last year).

It is really late in the year, which means health insurance enrollments will be opening up soon. Do you have the option of changing plans? Maybe see what else is open? Just something to look into. I told my doctor that I wanted a referral for bariatric surgery on my first visit two weeks after I got on the insurance and there was absolutely no problem.

I think it depends on your plan. Maybe you can change your plan during open enrollment? Some plans have $0 co-pays, $25+, and some have deductibles. I'm also in CA, so not sure how the plans work in your state.

Wow. can location seriously be that big a difference? That's crazy to think in one state it's 250 copay and in another state it's 14,000...

I have Kaiser NorCal and I work for a big

Bank that only offers co insurance plans. I enrolled in the best one they offer and I have to pay $2000 which is my individual out of pocket max. We used to have the $250 copay with my hubs

Company but they no longer offer Kaiser.

Sent from my iPhone using the BariatricPal App

Yes, I have Kaiser of Colorado and their plan only covers 50%. What's really frustrating is that I used their estimator which states it uses my plan information to estimate, which I why I started the process. And then they turn around and say 50%. is all they cover and the entire bill is $28,000; so my share would be $14,000, and that's just for the surgery. I still have deductibles for speciality appointments with the doctor, mental health and the classes leading up to the surgery.

It just seems crazy...and I just need to research and see if there is something I am missing.

Thank God I found this post! I am in the exact same boat as you. I am also with Kaiser Colorado with a 50% benefit for bariatric. It is refreshing to hear you were quoted the same amount as me for Saint Joseph's, including the deposit amount. This issue also came up with another girl in Colorado but her plan pays less and they told her she has to pay almost $7k before the surgery which is absolutely ridiculous. Part of my issue is that I am starting the six week classes on October 27th and I have been on this journey for almost a year because I had to lower my bmi by 10%. Therefore I am completely invested with Kaiser and do like my services with them. My open enrollment is coming up in Nov and I may have to switch to Aetna which has an out of pocket max of $3k because they consider the surgery medically necessary when approved. The issue with Kaiser is bariatric pays completely different than other inpatient stays. I would normally have a 10% copayment up to $1500 OOP max. Bariatric coverage states the OOP max does not apply. I read somewhere on here that if you have to have another procedure such as a hernia repair that this benefit would kick in first for facility and anesthesia so you would only have to the additional cost for the surgery only which is only around $1500 for kaisers contracted price at 50%. I am tempted to see if I need a hernia repair just to test this theory. I asked both Kaiser and st Joe about financing and was told they consider the procedure elective so they likely would not offer this benefit for the surgery but I Still plan to try. I too was mislead by the online estimator and was told 1500 max OOP. I called into the regular benefits center before i even started and they confirmed this amount so imagine my surprise when I recently received this new figure from the counselor. I am looking into every option I can before open enrollment ends on Nov 15. I plan to call today to see is self pay would be cheaper and to ask if Kaiser if I can switch to the Colorado Springs area which is probably cheaper. Anyhow I will let you know if anything changes.

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