I am sure this has been asked, however after looking through several pages of posts  I can not find it....

So I apologize in advance if I am redundant.

Lets start with me Owning upfront I am no Insurance wiz at all, Here is what I have been told from my Company, GEHA  for Government Employees.

So first, I am looking to have VSG Surgery, and from what I understand on these forums and from Google, the average cost in my state of Kentucky fall in the ball park of 16-20000.

My Surgeon is in Network........so there is one plus

I contacted my Insurance asking the basics, their response below in red:

 

Please see the attached criteria. Services would require prior approval. Under Standard option approved services are subject to the $350.00 calendar year deductible and then payable at 85% of the plan allowance if rendered by an in network provider and 65% of the plan allowance if rendered by an out of network provider.

 

Still confused and unsure I emailed back asking

What are the max out of pocket costs and does this include my deductible: 

 

For 2016 Standard option, the maximum out of pocket is $7,500 for in network and $9500.00 out of network. 

Never got an answer as far as is my deductible included, so I am guessing its not and its an additional cost.

 

 With all this now said:

I contacted my surgeons Insurance/billing specialist and asked her to get me some numbers based upon this information:

So her response is in red.

Your not going to meet your out of pocket max. I do not have specifics on what the facility gets paid but I have a good idea. By my calculations you are looking at about $2100 to $2500 (that's without the deductible being included) Please know this is just an estimated guess, but I do come pretty close :)

The surgery thru insurance is about 12 to 15 thousand for the band. You will pay your deductible and 15%. For the sleeve it's around 16 to 20 thousand. 7500 is your max out of pocket for the year not what percent you pay. I know they make it confusing. 

So please someone, guide me here, I have concluded that this is how it is going to fall.......

I am again opting for the VSG surgery, so  18000.00 X 85% insurance coverage 15,300.00 covered= leaving 2,700.00 plus 350.00 deductible so about 3000.00 to me to pay before surgery........ am I getting it?  is this right?

I am not complaining, thank you Lord above for my insurance, however, if this is the case I need to step up the savings even more than I thought........

Advise Please

Thank you and Merry Christmas

 

 

 

Thats exactly it.

 

Your 15% of the total is $2700 + $350 for your deductible= $3050 your portion of the procedure. As you know this is a guesstimate.

My profession is dealing with insurances and everything that comes with it.

If I can help any further let me know. 

Yup, this is exactly how mine worked out.

First off, everything outlined above is correct.  The amount you will pay should fall about $3000 or below.   You will have to pay the hospital and anesthesiologist as well, but those can be billed to you after submitting to the insurance.  

I have been in the insurance industry for over 25 years as well as working Bariatric Programs and Hospitals.   It is nice to see a the staff at your surgeons office providing you with accurate information and great customer service. 

Best of luck to you on your journey! 

Nik

"so about 3000.00 to me to pay before surgery........ am I getting it?  is this right?"

The numbers are right as others have said.  I have Federal Blue Cross/Shield and they are paying for my TT on 2/16/16. I have a $350 annual deductible as well and they pay 85% and I pay 15%  of procedure, surgeon fees, and anesthesiologist fees same as yours.

I don't think you have to pay the money up front before your surgery. I  know that I don't. It is like any other surgery or procedure you have at the hospital. You get the bills in the mail afterwards. If you have a baby or knee surgery for example you get the bill in the mail it is not due up front.

Good Luck and Merry Christmas!