self pay vs insurance

If I go the slef pay route, about how much does this tupe of WLS cost?  I have Viva Health and they can't give me a straght answer about whether this type of WLS is covered or not.  Overthe phone they say yes and send me the detailed info and it is always for the gastric bypass instead.  I also wonder how much do you pay out of pocket if yu go te insurance route by the time you py for allyour MD visits, psych eval, supervised diet, etc? 

Your insurance campany can give you a straight answer as to whether or not they will cover a VSG.

Write to them and ask them this very specific question: 

"Under my policy (and give your policy number) is the Vertical Sleeve Gastrectomy, also known as the Sleeve Gastrectomy, a covered form of weight loss surgery?"

Second question:

"If this surgery IS covered, what specific criteria do you require to be met, in order to approve such surgery?"


By law, they MUST provide an answer to those questions to any policy holder.  Do NOT call them, do this in writing.  They do not have to answer a question as complex as this possibly is over the telephone, and most of the people that you deal with on the telephone couldn't answer it anyway.

I went to an AMAZING doctor and self paid. It cost me $12,500 out of pocket and that included hospital stay for two nights, surgeon fee and anesthesiologist. I HIGHLY recommend dr Jossart!
Good luck!

Get the procedure code for VSG from your surgeon (I'd tell you if I remembered). Then they can DEFINITELY tell you if it's covered.

Theanks for the advice on putting my request in writing and getting the procedure code.  It is also good to know that it would proabbly be less than $15k out of pocket if I go that way too.  Not sure I want to try to jump through all the hoops now that I feel ready to do something.  I also wondered how much you would pay out of pocket anyway jumping through all the hoops. 

I think I will get my request in writing to my insurance company and go from there. 

Thanks so much for the responses!

 I only paid $2,600 total (ins. pd the rest).  I have a $500 deductible, max $2,000 out of pocket, plus $100 per day hospital copay.  Worth the hoops (though my approval was seamless).  Saved me $6- 8,000...

my insurance pays 80% of the VSG, so I am assuming 4k or so. I can get it self pay in mexico for 8999 (or cheaper but I dont feel comfy with any of the cheaper doctors)

I have Viva Health also and they faxed it to me and when I choose a doctor the information was the same.
 

My ins paid 80% of my surgery so I ended up paying $3300..

I was going to be a self payor at first then I found out my husband's insurance would cover it, and for self pay at my hospital the cost is $15,000

Susan

Self pay cost depends on where you live.  I live in Jax fl.  I checked the price of self pay here and its 16k.  Maybe be less expensive where you live.

Good luck.