$7000 out of pocket!What! I have Insurance!

[needtoseemeagain 0]

Oh my goodness:w00t:! I was so excited about moving forward in this, I get a call from the office person and she tells me that with my insurance I still have a $7000 out of pocket amount, $4500 that is for supportive care post op that is not charged to my insurance at all! The coinsurance & deductible I get, but the non-negotiable pay before surgery $4500 is so much. Is this normal? Can anyone elaborate, is this what everyone does?

[MacMadame 81]

Define normal? :thumbup:

Some offices do it. so it's not unheard of, but it's not universal either. They call it a program fee. It covers all your aftercare and some other stuff that generally insurance won't cover. Of course, if you have insurance that covers this stuff, it's annoying, because they won't waive it for you.

My surgeon has a big staff that we can access. This includes a nutritionist, a counselor, a monthly newsletter, seminars all over the area each month, a surgical coordinator, a patient coordinator, and some other staff. Someone has to pay for it and much of that stuff isn't going to be covered by insurance. (Though mine would cover the nutritionist and counselor. Too bad they don't cover the actual surgery!)

OTOH, some surgeons don't have program fees or have much smaller fees. Sometimes this is because they don't have those expenses. Which means the after-care may not be as good. Sometimes it's because they are working through a hospital or other non-profit and the expenses are covered in other ways.

Because I was self-pay, I didn't have to decide if it was worth it to me to pay the program fee that my surgeon charges. I feel for you being put in this position.

[youknowit 11]

Hey there! I'm in a bit of a different situation than you are, as I'm trying (unsuccesfully) to get my leaking/broken band REMOVED, and I've gotten the same thing. The ONLY office my insurance (HMO-gggrrr) will allow me to go to asked for $3000 UP FRONT to even see me, because I didn't have my band with their office. We went round and round, let's just say I didn't pay the $3k. I did pay $300 out of pocket just to walk in the door (according to the office and my insurance, they don't pay for "consults", grrr again)... where they told me once I had my "consultation" that my copay WITH insurance to have the band removed is, I hope you're sitting down... $11,000. Shocking, and insane. They told me, after going round and round that if I didn't get my band "replaced" they could knock of the cost of a new band, but that my surgery, just for removal, would still cost ME $9000. WITH INSURANCE. My "insurance" says they will pay up to $5000 FOR LIFE regarding bariatric surgery. We all know that isn't even gonna scratch the surface. They told me getting my band removed is my best choice, because if I get it replaced... I won't have any further coverage (EVER) if there is a problem. TOTALLY BS... grrr again. So... I don't know what to do either. Everyone (Allergan, my doc, the doc here, etc) keep saying "you can just leave the band there, it's not hurting you"... which may, or may not be the case, physically. It is hurting me mentally; I'm so tired of this battle, and I just want this thing OUT!

I wish you the best of luck in your journey... the band DOES work (as long as it doesn't break). :thumbup:

[needtoseemeagain 0]

Thank you MacMadame ... defining normal, in this case it just means, I didn't want to hear that ...:blush:lol. I was so surprised at the amount! However, you make sense and have said basically what she told me about the aftercare. I want to do this for me, if were anyone in my family, I wouldn't have reacted, it is time that my health and wellness be worth the investment.

Though I want to be healthier, making a hasty decision financially is scay too. I wonder are there other COE's in So Cal that have great care and more reasonable cost? You know, I want my fatfree cake and to eat it too :thumbup:.

[needtoseemeagain 0]

Thank you "you know it" I am so sorry to hear this situation even exist for you. That is really a difficult decision. One never thinks that it will be them that this happens too. Is is cheaper in places like Mexico since your out of pocket is so high anyway? I am not familiar with those doctors, but there are many threads on them and very satisfied people, perhaps they can help?

[MacMadame 81]

I wonder are there other COE's in So Cal that have great care and more reasonable cost?

You should definitely check it out. The surgeons all do things differently so you may find one that doesn't have a program fee but has a really good track record.

But in the end, you need to pick the best program, because that's how you have success. LapSF is seeing EWL with the band that is 10-20% better than published averages. That's nothing to sneeze at. If your surgeon gets results like that, it's probably worth the fee. If some other surgeon without a fee gets results like that, then it's worth switching.

Bariatric surgery doesn't seem to be a field where "you get what you pay for". Some places charge outlandish fees and haven't got great programs and some places with great programs don't charge much more than average. Definitely do your homework!

[needtoseemeagain 0]

MacMadame, that makes perfect sense. I want this for me. This seems to be my crossroad. I will do more research today. I need to narrow down a doctor while I have time. There are 2 deminars coming up and I really would rather start with only one doctor and complete the cycle. Thank you so much for your help, you are a great resource.