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How to determine amount of insurance coverage?

Candle

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Candle    11

Candle
Posted

This just doesn't seem right to me ...

I had a consult w/ a surgeon back in Jan. I don't think I plan to pursue surgery with THIS doctor. His office staff was very nice and helpful - they submitted a request to my insurance just to see if they will cover any part of PS.

To my surprise and delight - they will cover the panni portion of the TT. I have an approval letter for code: 15830- panniculectomy. The surgeon suggested an extended TT and I was quoted $9,500. He is out of network, so I know my coverage is 70% of the contracted rate, after a $2,000 deductible. No one from my insurance co or the doctor's office can tell me how much I will be liable for.

I'm expected to go into surgery and not find out until AFTER if I have to pay anywhere from $2,000 - 9,500?

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Dr. Schulman    2

Dr. Schulman
Posted

This just doesn't seem right to me ...

I had a consult w/ a surgeon back in Jan. I don't think I plan to pursue surgery with THIS doctor. His office staff was very nice and helpful - they submitted a request to my insurance just to see if they will cover any part of PS.

To my surprise and delight - they will cover the panni portion of the TT. I have an approval letter for code: 15830- panniculectomy. The surgeon suggested an extended TT and I was quoted $9,500. He is out of network, so I know my coverage is 70% of the contracted rate, after a $2,000 deductible. No one from my insurance co or the doctor's office can tell me how much I will be liable for.

I'm expected to go into surgery and not find out until AFTER if I have to pay anywhere from $2,000 - 9,500?

In general, 15830 will reimburse about $1800 - $2500 (obviously this varies among insurance providers, but this should give you a "ballpark" idea). It is possible that this will go towards you deductible and you will only get a small amount of reimbursement. Your PS office should have been able to give you an idea about this amount, because they have probably experienced this before.

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Candle    11

Candle
Posted

Thanks Dr Schulman

I was thinking it would cover about a 1/4 to a 1/3 of the cost.

I'm coming to see you in April. I had to cancel my appointment this month, emergency gall bladder removal on St Patty’s Day.

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Go To Topic Listing Plastic & Reconstructive Surgery

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    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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