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Deductible

Rocky80

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annam1978    1

annam1978
Posted

Me also. My surgeon consult is Friday and they submit to insurance. They are booked up for December surgeries so mine will be in January. It’s sux to have to pay our deductible all over again


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biggirlc    29

biggirlc
Posted

Yup im in the same boat,, I wish I would have known I would have gotten all my tests done in jan,, now I have to pay double for surgery


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KimTriesRNY    1,853

KimTriesRNY
Posted

Yes, if your plan runs January to December you do have to start paying that deductible all over again beginning in January. Mine is 6350 so I’m glad I squeaked in!

That being said, it’s more costly to be obese and you will still save in the long run!

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BMC blogger    38

BMC blogger
Posted

Wow, my deductible is 347 bucks

Sent from my SM-G950U using BariatricPal mobile app



Agreed - the deductibles are based on service date, so if surgery doesn’t happy til after December and your plans run Jan-Dec you will have to cover it again.

Also be sure that you know the difference between a deductible and your “out of pocket max”. Just because you met the deductible doesn’t mean you won’t end up paying toward surgery. Most insurance companies won’t cover 100% until you’ve reach the out of pocket max.

For myself, my deductible is 400 per year. My out of pocket max is 2000 (in network). Surgery is covered 80% (I think) so I’d be required to pay 20% or up to 2,000 (the out of pocket max) whichever gets hit first.


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kjensen    5

kjensen
Posted

Another thing....make sure everyone involved in your surgery is in-network with your insurance. My friend had surgery a couple of months ago and found out afterwards that the anesthesiologist was out of network. She had to pay $5,000 out of pocket! My surgeons office was able to confirm the surgeon (obviously) and the hospital are in-network, but I had to make additional calls for the anesthesiologist and surgery assistant.


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

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    • Eve411

      Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
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    • Clueless_girl

      Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
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    • KeeWee

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      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
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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. 
       
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    • 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
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