Question:
how much out of pocket can I expect

Some surgeons I have called say they can get me approved with my insurance but then it is $2,500 - $3,000 out of pocket for After care? Is this true in all cases or how about BTC , do they charge this also. One place wants 12 months of prepaid visits to the nutritionist(I think) HELP!! I am confused. But I am determined!!    — Sandy L. (posted on March 7, 2003)

March 7, 2003
I don't know what "Aftercare" they are refering to. I am 3 weeks Post Op from BTC in Wylie TX. I was in the center for 3 days, typical, then home. There was no professional healthcare required in my case. As far as out of pocket expense that is with respect to your insurance plan and there is a BIG difference in coverages. I had to pay a total of $2500 OOP and that was due to the nearest BTC being out of my plan area. I will say the people at BTC in Michigan, the corporate HQ, were the best! Ask for Thomasina she will guide you all the way. In the end you may consider finding employment with a company that offers CIGNA insurance. They are reputed to be the most receptive to those with high BMIs, that is to say, morbid and supermorbidly obese. Best of luck! I love my WLS!! Don
   — Phitphreak

March 8, 2003
Your out-of-pocket will be entirely determined by the terms of your insurance plan. I had my surgery at BTC. My deductible is $460 and my yearly out-of-pocket maximum is $2,000 on top of that...so I'm looking at paying $2,460. I have required aftercare - I have a nurse coming to my house twice a day to take care of an open, draining wound. Since I will have met my yearly maximums in paying BTC, this aftercare will not cost me anything extra. 2-week, 6-week, etc. post-op visits to BTC are included in the cost of your surgery...and these visits include the consults with the dietician.
   — Amy W.

March 9, 2003
As the others mentioned, I think it depends on your particular insurance plan. My nutrition consult was $200, and I am going to try to submit for some reimbursement. The psych eval was free, as a friend did it for me. So far, even my follow ups have been covered. No one asked me for the $20 copay. If you want the real truth, the biggest cost was the parking garage near the hospital (in NYC) which cost us almost $400 over a weeks time and the tv and phone $10 a day. I suppose I really shouldn't complain, but the parking thing really got to me. My husband was so tired and stressed, that I didn't have the heart to have him search for parking for hours in the city streets.
   — Fixnmyself

March 9, 2003
I am still pre-op but the approval letter I received from my insurance company in 2002 said I had to meet my $400 deductible. After that all expenses would be paid at 90%, my share being 10%. The great thing about my insurance is, I have a "Max Out Of Pocket Expense". This amount in 2002 was $700. I called my insurance company last week to make sure I did not need to get approval again, since they approved my surgery a little over a year ago. I was told I am still approved as long as I am going to the same doctor/clinic. If I decide to see another doctor, I would need the doctor to get approval, this has to do with me seeing a doctor in network. They did inform me that my "Max Out Of Pocket Expense" has gone up to $1000 this year. I wanted to make sure I understood her correctly so I asked her if that meant I would pay my $400 deductible plus $1000. I was told no. I would pay my $400 deductible plus $600 out of pocket. I would check with your insurance and ask what your "Max Out Of Pocket Expenses" are. I hope this helps some.
   — Maria S

Click Here to Return