I want to cry....In fact, I kinda am.....
So…I have been trying like mad to get on my husbands insurance because it’s such a lower deductible and cheaper, and I couldn’t speak to the bariatric services to get the info on what was covered for the sleeve surgery until I was added. My husband couldn’t even ask because he wasn’t the one to be having the surgery. Finally get added today…and I call. For 100% coverage I would have to use a surgeon in Omaha-which is about 50 miles from where I live-Lincoln, and have to start completely over from what I have already done (Psych, Nutrition and fitness eval). Or I can keep my office and have 80/20 coverage (which is what I have with my insurance), I also have a $2200 out of pocket where his is $2000. The deductible is the big thing…his is $400, mine is $1100. AND I have to have a 6 month physician supervised weight loss program. With his insurance I wouldn’t be able to have the surgery until March-at the earliest. I just want to cry. He is so focused on the cost and deductible difference that he can’t see anything else. I can’t wait another 7 months. I have done so much work this past month and have been preparing mentally for this…..
I have not dropped my insurance, I could just change it to cover me and drop him. I need him to see my side that I cannot wait another 7 months... I have to convince him that I need to use my insurance.
Besides the deductibles you need to look at what the additional costs are going to be if you have to start all over. On the surface it looks like his deductibles are cheaper but once you add back in all of the extra things you have to do is it really that much cheaper in the first year?
Highest Weight: 285 SW: 264.6 CW:163.1 Surgeon's GW: 189 PCP's GW: 165-170
My GW: 154 MFP: jteaford
on 8/16/13 8:03 am
if you went to Lincoln, are you sure they won't taken anything that's already been done? call over there and talk to a nut or a weight lost doc to see what they can do for you?
I was kind of where you were when I was trying to schedule my surgery. It either had to happen 2 weeks ago, or I couldn't do it for another 6 months due to work/teaching/etc. Call and talk with someone who schedules and does the paper work. Tell them you need help in he process and see what they can do. DON'T give up...you'd be surprised at what they can do to help!
I actually went to a doc 30 miles from my house--whi*****hicago is almost 1-2 hours away depending on time of day. It was totally worth it to me. I work at the medical center he is at, but it would have been more convenient if I'd been closer.
I second this, I had to switch doctors and hospitals 3 weeks before I was scheduled for surgery. The new office really worked with me to make sure that everything was sent over and they only made me have 1 appt with the surgeon and 1 with the NUT. It did cause a delay, but only by about a month and a half.
I know the cost factor is a big thing (I'm an accountant so I get it). My insurance didn't cover ANY bariatrics so I was a self pay patient and I cannot tell you how much this was worth every penny! Throw this out at him...the sooner you do this, the sooner your weekly/monthly food bill is reduced - significantly, I might add. Studies have reported that the average bariatric patient saves approximately $15,000 per year in medical costs and food. That's $8,750 for 7 months....how's that for some creative accounting???? Good luck!
Goal Reached in 12.5 Months
HW: 274 Pre-OpW: 266 SW: 254 CW: 125 GW: 145
You must permanently change your lifestyle if you want your weight loss to be permanent. You can do it!
Take heart, it's not as grim as it appears.
Call the Omaha Bariatric clinic, perhaps some of the work you have already paid for and completed will apply
Also, be sure to account for expenses for the commute, it adds up
100 mile round trip. Current rate for expenses if 50 cents a mile. For a six month pre-op routine, you would need to make the trip at least 8 times to 10 times. During surgery, you/your husband will need to make the trip at least 3 times. Post-op follow up is going to run you at least another six trips. All total you are looking at like 17 to 20 trips. At 100 miles round trip, that's 1700 to 2000 miles of driving to cover the commute to Omaha to get it done. At 50 cents a mile that adds up to between 850 and 1000. Add in the incidentals like eating out that long drives encourage and this is probably a hidden $1000 cost to your overall experience doing it using the long commute. Insurance won't touch that at all.
Even if you just account for fuel and one oil change at 2000 miles assuming you get 20 GPM, you will need 100 gal x 4 = $400, add in an oil change for $50 and just using a minimalist approach. your at $450. Add in meals and you are still pushing $500 add that to the $400 deductible and you are already at $900 so the REAL difference between the two deductibles is closer to $200. The real question to ask is what is the lost opportunity cost to conserve that measly 200 bucks. Just point him to the great s3x posts after you ask that question and see where that gets you. Once you factor in the additional post op care, this is really a wash.
Factor in the lower bills post op for food, restaurants and medical and getting it done sooner is by far the best choice both financially, emotionally and well to be frank from a marriage perspective as well.
After you are done showing him all the numbers. Take his hand, look him in the eyes and say something like, " Can you place a price tag on having a happy wife, that my dear is priceless. I need you to be my hero and get this surgery for me now. I need your support and I love you. Please help me find a way to make this happen as soon as possible, I need you to be my hero". Than give him a big kiss and show him some of the great before and after pictures (look on my profile). Tell him that the ROI is incredible. :) Wink, wink.
find out exactly what the costs are 20 % can be alot of money , my surgeon said the surgery was $37,000 for self pay , but I seen a friends bill that was sent to his insurance company that said $100,000, I don't know if that includes all the testing or what
but if you need to pay 20% of that that is $20,000,
most surgeons will take all if not most of the first surgeons tests as long as there done in the USA
It took me 10 months from when I first seen my surgeon till my surgery , this can be a long process, but it is best to do it right
my surgeon said I could see any doctor for all the test but I used his to make things easier
your hubby can stay at the hospital or at a motel for the 2 nights you will be in the hospital , and I bet you drive the fifty miles all the time now to go to town
which surgeon is a better surgeon is a better question ????
You need to REALLY check your policies in this situation. I am a director at a hospital, and one of my departments is billing. Many to most commercial insurances these days look at a claim to see what they would have paid if primary, and if the actual primary paid as much or more than they would have as primary, they won't pay any additional money as a secondary insurance. This makes secondary policies for commercial insurance not worth the cost of the premiums in many cases.
Wouldn't your husband's policy be secondary to your policy? In my situation, the 2ndary paid their % after the primary paid. If that's true..are you still required to travel to Omaha for them to pay after the primary?? Also, I would point out that you have medical records to prove you've already done the pre-op requirements and that it will save your hubby's insurance $$ if you don't have to do them again. They may go for it, as insurance (and everything) is money driven.
on 8/16/13 6:33 pm
Everyone said what I wanted too, so make those calls and double check everything!!
Had my VSG on 9/11/13
5.5ft - HW 248 - CW ??? (Break from scale due to new meds)
I have after surgery "complications/side effects" that I fight daily.
(Read about some of it in my OH blog)
(Hubby had his VSG on 9/18/13 with no complications and is down -120 lbs so far and off all his meds!)