Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Did you have to pay anything with insurance?



Recommended Posts

I am having bypass surgery March 3rd through insurance approval and when my coordinator called to schedule my consents. She said I didn’t have to pay a deposit to my surgeon because my deductible was met. When the scheduler called to schedule my appointment and pre op paperwork appoint for 2 days before surgery she did not mention I would have to pay anything. I just don’t want to get to the hospital and they want 4,000.

Share this post


Link to post
Share on other sites

If your deductible is already met, and your maximum out of pocket is as well, you should be good to go. Just call your insurance company.

Share this post


Link to post
Share on other sites

12 minutes ago, bufbills said:

If your deductible is already met, and your maximum out of pocket is as well, you should be good to go. Just call your insurance company.

I called them that’s why I’m so confused one person said this and another person said something totally different. My out of pocket isn’t reached yet unfortunately it’s a new year. Would’ve been nice if I could’ve had the surgery last year lol.

Share this post


Link to post
Share on other sites

My deductible was met, but I still had an out-of-pocket maximum to meet, which was $1200.

Share this post


Link to post
Share on other sites

22 minutes ago, GradyCat said:

My deductible was met, but I still had an out-of-pocket maximum to meet, which was $1200.

When did they let you know how much you had to pay?Was it before you went to the hospital or the day you went to the hospital? My pre op appointment is March 1st my surgery is March 3rd. I still have claims processing on my insurance so I’m not sure what my out of pocket will be because the claims haven’t been fully processed yet.

Share this post


Link to post
Share on other sites

2 hours ago, Chantrella said:

When did they let you know how much you had to pay?Was it before you went to the hospital or the day you went to the hospital? My pre op appointment is March 1st my surgery is March 3rd. I still have claims processing on my insurance so I’m not sure what my out of pocket will be because the claims haven’t been fully processed yet.

I knew BEFORE the surgery, by the pre-op date. I had to pay 25% up front on the day of surgery before they'd let me have the surgery (to the hospital, not the surgeon). You could call your insurance company to see if they can give you your Out-of-Pocket remaining balance estimate based on pending claims.

Share this post


Link to post
Share on other sites

I think by the time I had my surgery (in the summer), I may have been up to my out-of-pocket limit because of the classes, appointments, and all the tests I had to take before I was approved (sleep study, nuclear stress test, EKG, labs, etc)

Share this post


Link to post
Share on other sites

The total you should have to pay is you deductible plus your out of pocket maximum i.e.

$600 deductible + $1200 oop max = $1800

If you have met your deductible, you only need to pay up to your oop maximum, but usually after you have met your deductible, you pay a percentage such as 10% or 20% of any bill until you meet your oop max, i.e.

$12,000 hosp bill × 10% = $1200 which meets your oop max. Any bill after this would be paid 100% by insurance as long as providers are in network.

Share this post


Link to post
Share on other sites

The billing in the whole situation confused me so much. Everything up to the surgery was simple, I just paid my $15-$30 copay for every doctor's visit. For the surgery, I was told in advance that my portion would be ~$200 and I had to pay it on the day of the surgery. At the time I was 23 years old and I did not have much money at all so I made sure to save money so I would have that $200 for my surgery. When I got to the hospital the day of my surgery they gave me a bill and I owed them just under $700. I just paid the $200 that day and explained to them that I was told $200 and I would be able to make payments. They didn't have an issue with that (thankfully).

Share this post


Link to post
Share on other sites

On 2/6/2021 at 1:19 PM, Uomograsso said:

The total you should have to pay is you deductible plus your out of pocket maximum i.e.

$600 deductible + $1200 oop max = $1800

If you have met your deductible, you only need to pay up to your oop maximum, but usually after you have met your deductible, you pay a percentage such as 10% or 20% of any bill until you meet your oop max, i.e.

$12,000 hosp bill × 10% = $1200 which meets your oop max. Any bill after this would be paid 100% by insurance as long as providers are in network.

Yes I have met my deductible, but not my oop max just yet. I think I understand you. I am still in my coinsurance phase so I would be paying 10% of my surgery total?

Share this post


Link to post
Share on other sites

1 hour ago, Chantrella said:

Yes I have met my deductible, but not my oop max just yet. I think I understand you. I am still in my coinsurance phase so I would be paying 10% of my surgery total?

I know you didn't ask me this, but yes, that's how it works with most insurance companies - although yours may be different. You could always call them and ask - then you'd know for sure.

Share this post


Link to post
Share on other sites

34 minutes ago, catwoman7 said:

I know you didn't ask me this, but yes, that's how it works with most insurance companies - although yours may be different. You could always call them and ask - then you'd know for sure.

Yup, I called them I pay 10% until I reach my oop max. Thank you that really helps me figure out how much I will be paying on the 1st.

Share this post


Link to post
Share on other sites

Update for everyone my coordinator called me today to ask if I knew how much I had to pay for surgery at my pre-op. I told her yes 10% of the procedure since so am in coinsurance phase. She told me that didn’t sound right and to call the hospital they would know for sure. So the hospital said I have the best insurance because all I pay is 300.00 everything else is covered. A little lost I called my insurance asked to speak to someone high up and they too confirmed only 300.00. Like wow! I haven’t even met my out of pocket yet. So thankful I decided to get the more expensive policy for 20 extra bucks a month.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Topics

  • Recent Status Updates

    • cutethickmoma

      Ok Bariatric Pals it's been a long time! I'm back and in need of help had the sleeve done back in 2013 regained some weight current 280 looking to have a revision done. Any suggestions 🤔 
      · 0 replies
      1. This update has no replies.
    • KTNCANDY

      6 days post op..
      Hight..5'4
      Highest weight...350lbs
      Pre op weight ..315 on 2/15/21
      Post op weight.. 335   2/16/21
      Day 6
      -10.. 325
       
      Alot of swelling.  But up and about.  Started full fluid diet today. 
       
      · 0 replies
      1. This update has no replies.
    • Annie2021

      Waiting for a sleeve.... any comments on positivity ?
      · 2 replies
      1. Grayce

        Just keep in high spirits. I'm 9 weeks post op and I'm glad I did it. Do you have a surgery date?

      2. Neensyb

        7 weeks post op here. Take one day at a time.

    • CrowLuv

      It's been so long since I came here and I'm disappointed in myself for that, it's such a wonderful forum with amazing people. 
      But I'm back with exciting news: I had my surgery in August of 2019, and I met my goal of 180 by the fall of 2020! And even better: as of today I've far surpassed my initial goal and am now at 156lbs!
      In hindsight, I made the goal of 180 never dreaming I would be able to go below that, and yet, in the back of my mind I always knew that somewhere in the 150s would be the absolute ideal for me, I just never thought that would be a possibility, even with this surgery. So this is a dream come true for me!
      The mind is a very powerful machine, and I guess my mind clearly said "we're not done here" when I got to 180. I didn't even try to get below it, to be perfectly honest - it took no effort on my part, the weight just kept (keeps?) melting off of me. 
      That sounds like the worst kind of humblebrag, almost cringe-level - but I truly don't mean it that way. It's just that I'm just completely gobsmacked! I never in a million years expected this to happen!
      More good news: I started exercising with a program I'm obsessed with called Essentrics last October - heck, I've only missed a handful of days since I started. I never in my wildest dreams thought I'd be so excited about working out, that it would be the highlight of my day, even. But it is! I always haaaated exercise! But this program is downright enjoyable and I always feel something akin to euphoria at the end of my workouts. That's not an exaggeration. It's possible that doing this is why I kept losing weight, but I'm not sure, because it's not cardio-heavy at all...it's more like just stretching and moving your body, I guess kinda like a more "active" form of yoga, but NOT yoga, it's hard to describe honestly. Nothing fancy, it just really feels good for my body, I can't say enough about it. I can't imagine it burns that many calories since there is very little cardio involved, but I don't know because I don't do math and that's that lol.
      But now I have a new goal, and it's a big one: get back to a nutritious, healthy diet (maintenance I mean, not active weight loss). I'm embarrassed to admit it, but I have to be brutally honest with myself, and this is the ideal place to do it - the fact is, my diet SUCKS. I haven't even tried to eat healthily for quite awhile now. I'm so ashamed of myself just typing that out, but I need to face it and admit it to myself before I can fix it.
      I haven't participated on this forum for way too long, and that was a mistake. This forum is amazing and filled with such great people who always inspired me so much!
      So now I'm back because, even though I'm at my goal, the fact is, this is a lifelong journey - it's not just the weight loss part, it's so much more than that. I need help getting my diet back on track. I need the inspiration and excellent advice I always found here. Just because I'm at goal doesn't mean I'm done - far from it.
      So although I'm embarrassed that my diet (currently!) sucks, I can at least give myself credit for finally admitting it and setting my intention to change that. Being at goal weight does NOT mean I'm healthy. It's great that I'm exercising, but if I'm not giving my body the nutrition it needs, then I'm only hurting myself. If I took the giant step of having bariatric surgery, I owe it to myself to follow through with the WHY I did it - which was to become healthy again - and that is sooo much more than a number on the scale.
      I'm ready to make the changes necessary to get myself into the healthiest state possible. I won't be perfect, nobody is, but it's time for me to truly commit to giving my body the healthy nutrition it deserves as best as I can. I don't know where to start though, it's like I need an entire education about it. But I'm ready and willing to learn.
      I'm so happy to be back here because I know that inspiration is found everywhere here in this forum.  
      · 2 replies
      1. kunkelgw

        Welcome back and congratulations with your added weight loss. That is so wonderful.😀

      2. CrowLuv

        Thank you so much! :)

    • summerset

      I feel like a sponge soaked with water this weekend. Noticed it yesterday already, also today. TMI I guess but this feeling of having peed and then this strange feeling in the bladder that lasts for a while - like you still have to pee.
      · 1 reply
      1. BayougirlMrsS

        I went to the dr. yesterday.... he put me on Bactrum. Starting to feel better

  • Recent Topics

  • Most popular:

  • Together, we have lost...
      lbs
    ×