Ok, I have United Health and I am one appointment from submitting all information to the insurance company.

United health has issued a case nurse advocate to help me with the process which has been wonderful.

But I have a question: United Health Care will pay 20.000 of my procedure, but I also have paperwork that says this.

Deductible 250.00 (which had been met)

90/10

Out of pocket 2000.00

So my question is this, will I owe anything above 20.000 , or the out of pocket max.

Thanks

Julie

Ihave UHC too and I did. By the time the surgeon, hospital, anesthesiologist and radiologist submitted thier charges the total bill was around 29,000.00 (self-pay was quoted at $17,500.00!). The insurance company did their bargaining and brought their part down to about 20,000.00 in the end I had to pay around $5,000.00 out of pocket. My surgeon required a $3,000.00 downpayment prior to surgery and with all of the other bills trickling in it added another $2,000.000.(my anesthesiologist bill came seven months after surgery!)

After you meet your out of pocket max and deductible you are done. You can verify it in your benefits book, but everything after your OOPM should be covered at 100%.

I think people run into confusion because someone with the same insurance provider has a different experience from theirs, but that is because everyone has different policies. It depends on the coverage your particular policy entitles you to and that depends on the contract you or your employer has with them.

I also have UHC and they paid 100% of my surgery. I had to paid for the anesthesiologist. I just got a bill yesterday actually. It was $184.00. Not bad though. My dr billed my insurance $36,000.00 for my surgery and they got paid $3000.00. Big difference! All UHC plans are different though. The best thing to do is call customer service. This will give you an idea of what to expect. Customer service actually told me that I would pay almost $2000.00 out of pocket. I never did. So that's why I say at least you will have an idea.

An out of pocket maximum is the HIGHEST amount you could be responsible for. If the surgery were to come in at less than $20K, you'd only be responsible for 10% of that. I'd count on the $2K as your out of pocket.

Another thing you'll need to remember is which services are in network and out of network as they will have different out of pocket deductibles. Also, submit all your bills, as in psych and nutritional eval, as they may hit towards your OOP.

Edited February 7, 200917 yr by oscarel

Actually everything is covered at 100% after you meet your deductible and OOP max UNTIL the insurance pays $20,000. Then YOU are responsible for 100% of the rest of the charges over the $20,000 maximum your insurance a,lows for the surgery. This $20,000 will include all bills associated with the surgery ie. surgeon, surgical assistant, hospital, lab, xray, radiologist, anesthesiologist etc. That also includes any post op charges after your 90 day global period that are associated with your surgery like fills, xrays, port replacement surgery in the future (if needed). You should be able to get quotes from your surgeon and the hospital of the esitmated charges prior to surgery. Some folks in your shoes find it is sometimes cheaper for them to pay cash, depending on the cash pay prices in your area. Then they save their insurance benefits for use after surgery.

Ok, I'm stil going through with the lap band but I can see that I need to sit down and figure this out.

All my appointmens are done I am just waiting for my doctor to submit it all to insurance, my bmi is in the 50's so I don't expect a denal. With that said still keep your fingers crossed for me.

When my surgeon gets my approval then we move forward to the pre op tests.

Thanks everyone

Julie

Ok, I'm stil going through with the lap band but I can see that I need to sit down and figure this out.

All my appointmens are done I am just waiting for my doctor to submit it all to insurance, my bmi is in the 50's so I don't expect a denal. With that said still keep your fingers crossed for me.

When my surgeon gets my approval then we move forward to the pre op tests.

Thanks everyone

Julie