For private pay, how much was your pathology report after surgery?

Roselane
on 4/15/19 7:07 am

Long story short, my insurance should have paid for my surgery, but they refused and I gave up after appealing once because otherwise I would have had to wait another eight months for surgery to work with my job schedule. I had surgery three months ago and I just received a pathology bill for almost $2,000. I was expecting a bill, but the amount was a huge surprise to me. If you received a pathology bill, do you recall about how much it was?

I am wondering if it was so high because they found a small GIST tumor in my removed stomach.

They say something about billing that amount to insurance, so I am also wondering if I should ask for an adjusted amount since I am paying out of pocket.

Thanks for your help!

Highest weight: 350, Surgery weight: 317

VSG: 1/9/19

No longer obese goal: 185, Healthy weight goal: 150

Weight loss per month: 1=22, 2=12, 3=9.5, 4=11.5, 5=8

mschwab
on 4/15/19 9:32 am
RNY on 11/21/14

Make sure they bill it to your insurance company. If the insurance company denies it, absolutely appeal. The denial would likely be because they view it as part of an uncovered service. You have t make the case that it was found as part of the surgery, but unrelated to the surgery

Also, if you end up having to pay the bill, absolutely negotiate to pay what they would have received from the insurance company.

Also, did you get a flat fee quote for the hospital and physician,lab, etc.? if so, it is unusual that they are billing separately for pathology. Call them and ask a lot of questions.

 Height: 5'7".  HW: 299, Program starting weight: 290, SW: 238, CW 138 - 12 pounds under goal!  

     

Roselane
on 4/17/19 7:43 am

I am following up on this just in case it is helpful to someone now or someone who searches this board later.

After calling them, I found out the following:

The bill was so high because of the tumor that they found; they had to run seven additional tests.

They had not actually billed my insurance, but had billed the place where I had completed the private pay (which makes no sense, since they said at the time that pathology was not included in that price). I gave them my insurance information for them to bill.

The woman I spoke to seems to think insurance will pay some since what they found was unrelated to the bariatric surgery.

They will also make a slight adjustment to the price (15%) if I do end up having to pay out of pocket.

Highest weight: 350, Surgery weight: 317

VSG: 1/9/19

No longer obese goal: 185, Healthy weight goal: 150

Weight loss per month: 1=22, 2=12, 3=9.5, 4=11.5, 5=8

diane S.
on 4/18/19 11:13 am

Many health providers give huge discounts to insurance companies under their contractual arrangements. Ask the pathologists what the insurance rate is and if they will accept that rate.

p.s. I had insurance (after appeal) and then they told me pathology was not covered. I found it in the policy where it was indeed covered and they said Whoops! sorry. I think they do that on purpose. ds


      
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