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Once approved...?

ashleey921

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ashleey921    62

ashleey921
Posted

Does your insurance company let you kno the total cost of the procedure and your total out of pocket cost of there is one? How does the whole process work once you are approved?

Everything was submitted to Humana by my surgeons office on wed and it was received thurs so now I'm just waiting.

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WiFiGamer    3

WiFiGamer
Posted

You can probably call your insurance company and ask them to break it down for you.

Every insurance company is different and there is no set price for the procedure so it would be in a case by case basis. Your insurance company would be the best bet to get that info. Your Dr office should be able to provide you with the total cost of the surgery but then it would be up to you too know your deductable ok Ed and find out how much you still be paying. I could be wrong about this but that is how mine worked.

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Lannie    135

Lannie
Posted

Your insurance could provide you with that information. You can ask for a summary plan description that will outline what is covered. The two items you would want to make sure you know is your deductible and your out of pocket maximum.

The deductible is the amount of $ you have to pay before the insurance kicks-in. You will have to pay the full amount of the deductible.

After that, most plans have co-insurance. That is where you split the cost with the insurance companies. An 80/20 co-insurance is normal. You will have to pay your portion until you hit the out of pocket max.

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ashleey921    62

ashleey921
Posted

Thanks.. I wasnt asking how much the procedure is though. I kno that varies. I was asking when you were given the total amount of the surgery and what your out of pocket would be. Does the insurance company give you that information or does it come from the surgeon's office? Was it as soon as you were approved in the letter? Or shortly after? I was already given my out of pocket from my surgeon before even getting approved. I guess they are basing it off of others who may have had my same insurance idk.

Im just asking so I can prepare myself and kind of give myself an idea of when I should schedule my surgery for.

change050117 reacted to this

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

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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.

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