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Out of Pocket expense after insurance

How much did you pay out of pocket after insurance paid their bit. I am trying to figure out if I can afford to have it done as quickly as I want.

I am not looking at total expence from those that didnt go thru insurance but from those that did.

Help please.:phanvan

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I paid $500 hospitalization copay, $175 for psych exam, and probably two or three copays of $20 for my doctors visits prior to surgery. Haven't had to pay anything since the surgery.

Good luck. It's well worth the money.

Sue

I would call the insurance company and ask for the CPT/ICD-9 codes for the procedure for coverage to make sure the billing specialist at the doctor's office is submitting the correct codes. I don't know why but they do have more than one code for the same procedures and if not submitted under the correct code your insurance can deny to pay that expense.

Make sure you right down the info and name and title and date and time of person you spoke with.

I haven't been banded yet...but I was told it is 100% covered and I will just need to meet my deductible of $500.

I am getting banded on 12/17 and am working with my doctor to make payment arrangements on about the $3000 I will have to pay. Good luck.

You can call your insurance company and they will tell you how much your deductible will be for the hospital. Most hospitals will allow you to pay in increments until you are paid up after your surgery. To answer your question, I paid the hospital $500.00. To see my doctor BEFORE the surgery I paid $40 (because he is a specialist it wasn't the normal co-pay fee), and $100.00 for a psch evaluation (directly to the pyschologist because she didn't take my insurance). Now that I am post OP I don't pay anything for the next five follow-up visits.

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i am waiting to hear back from my dr. I was told I have a $300 deductable and that they pay 90% of the first 10,000 and 95% of the next 10,000 So does that mean I am probably going to have to pay $1800

It seems like a lot to me. and I dont know how I am going to come up with that kind of money. but I need to have it done.

What do you think?

I had to pay my doctor $300 for the initial consultation and then $1500 for the surgery because he is out of network. I am also responsible for 10% of hospital cost. I'm not sure what that will be.

I'm from Sydney Australia and our health system is different to yours. My private health fund paid for the hospital costs except $500 which is the excess. The anaesthestist has charged me $1,300 but should get some of that back through medicare and my health insurance. The surgeons charged me $5,200 but that will cover the next 12 months of visits, including fills. Anything else they charge will be bulk billed (free for me). I should get around $700 back of that from medicare and my health fund. I guess, the overall cost for me is around $5-6,000. I have paid $2,000 so far and was told I could pay the last $3,200 on a monthly basis over a 6 month period. Happy with that. Already I think it's worth it. :whoo::whoo:

My out of pocket is 2500 a year. So that's how much I'll have to pay. I started this journey in July & my surgery date is Dec 13th. I haven't received any bills yet.....that'll be a scary day!

  • Author

I really apreciate all the information. I am basically trying to figure out how to come up with the money for the surgery. and this definitly helps me figure cost.

I know it will be worth it but I have to pay for it first.

I paid 350 to my surgeon before surgery. That covered the required meetings and nutritionist. 275 for the psych eval, 20 x 7 for copays to all other doctors and after ins. I should owe 1150 that the ins did not cover, but they have not sent me a bill yet. And 200.00 for the cpap machine that I found out I need

I paid the hospital $98 and I paid the physician $100. I had to pay the nutritionist out of pocket $150, but I might be able to claim reimbursement because I am a diabetic. I did not have to pay for my psych eval either.

It is likely there will be unforseen costs.

The cost of the Vitamins and Proteins have me a bit shocked.

I am not looking at total expence from those that didnt go thru insurance but from those that did.
I don't have a deductible to meet, and outpatient procedures are covered at 100% (inpatient would have a $250ish copay). I don't remember exactly, but my total OOP was something like $100 like this:

Consultation - $20 (covered everything around the surgeon)

Pre-admission at the hospital - $20 (covered everything around the hospital)

Psych visit 1 - $20

Psych visit 2 - $20

Psych visit 3 - $20

My fills are now coded as office visits & still covered under my intial $20 copay.

  • Author

Wow. I wish mine was 100%. I am looking at insurance covering 90% of the first 10,000 and 95% of the second 10,000 plus meeting my deductable.

So From what I understand I could end up paying 1,500. Plus meeting my deductable. Which is not bad but I wish I had thought about that cost in the begining of this process. So I could of started saving 6 months ago instead of now at the end trying to figure out how to gather the money in 6 weeks.

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