20% copay up to $5000 plus hospital fees??

After 2 years of trying to have revision surgery (cash pay), I now have insurance, but I cancelled the surgery in October because I had paid $2300+ to the hospital and hours before surgery they called asking for another $3500 for the surgeon. WHAT?? I tried to change doctors, but the next hospital was charging $5000 cash for removing the lap-band and the 1st hospital was only going to charge $1500. So, I am looking at paying $8000 out-of-pocket for a revision to bypass because my insurance does not cover the removal of the band and my 20% co-pay.

Does any of this make sense? I am so sad and worried. I need this surgery to save my health, but I don't have $8000 in the bank. I have $3500 in CareCredit, and $7000 with Enhance Patient Finanacing, but no one is Arizona takes that. So here I am, finally with insurance, but I still can't have surgery.

Thanks for letting me vent.

 

 

I'm sorry you're having such a difficult time.  I'm wondering why your insurance won't cover band removal?  Is that what you were "told" or is it in writing somewhere?  If the band is causing you problems, I would think the insurance would have to cover it.  UNLESS, they're considering a pre-existing condition and they won't cover it for a period of time?  

So sorry to hear this. This was /is my exact fear as far as insurance. But the bariatric nurse went over all the fees with me for my revision....it is listed as medically necessary.....did your paperwork say this? I have $150.00 co pay for surgeon, $150 per night stay in hospital. And the meds they will bill to me...i am responsible for 20% of that. I was cash pay with the band but now have insurance. Keep us posted.

Almost all insurances have a copay and deductable.  A deductable is the amount you must pay out of pocket for covered services before your insurance will pay anything.  The deductable usually renews at the beginning of each year.  A copay is the amount you pay out of pocket for every covered service you receive.   Some insurances will cap your out of pocket costs and pay 100% for all covered services beyond the cap.  It is very hard to collect a patient's deductable and copay after the service is rendered, so many hospitals and doctors collect up front especially for high ticket benefits like non-emergency surgery.  Some benefits are covered at 100% without being subject to copay or deductable, but they are usually health maintenance benefits like mamography, pap smears, well baby check ups, and prostate exams.