Insurance 50% Reimbursement with Cap
I wanted to post a heads up for anyone with partial reimbursement from your insurance company who is planning a surgery.
At my hospital, the self pay sleeve surgery is about $14,500. My insurance plan is 50% + deductable with a $10,000 cap. Given the self pay amount I figured I'd have to pay somewhere around $8,000. I asked my surgeon's office and the insurance company to confirm the amount (understanding that the real amount would vary based on my actual surgical experience). In all cases I was told that it was very difficult to estimate and I didn't get any better figure than my rough guess.
In practice I ended up paying more like $11,500 with my deductable. The charges seem fair and all parties did what they needed to do, but my own estimate was off by quite a bit. In talking with Aetna this morning, they said that the doctor, anestheiolgist, and hostpital could have submitted estimates that would probably have gotten me closer to the actual amount that I had to pay. So I have learned a lesson - if you are concerned about the final cost, talk to each provider and get the estimated costs to the insurance company in advance so that you can plan.
I gave feedback to the hospital and insurance company telling them that it should be easier to get an estimate but I wanted to get this information out in case it would help anyone that was arranging financing for a partial pay. Obviously if you are self-pay there are usually fixed price package and this doesn't apply. Likewise, if your insurance policy doesn't have a cap then you probably won't have as much of a surprise but it could still be more than you are expecting.
Hope this helps someone in the future. I'd like to state that this doesn't affect my satisfaction with my surgeon or the hospital who all did a terrific job and I wouldn't hesitate to recommend them or the sleeve to anyone. Even my insurance company was very helpful in understanding the outcome. This post is just intended to help people in their financial planning.
At my hospital, the self pay sleeve surgery is about $14,500. My insurance plan is 50% + deductable with a $10,000 cap. Given the self pay amount I figured I'd have to pay somewhere around $8,000. I asked my surgeon's office and the insurance company to confirm the amount (understanding that the real amount would vary based on my actual surgical experience). In all cases I was told that it was very difficult to estimate and I didn't get any better figure than my rough guess.
In practice I ended up paying more like $11,500 with my deductable. The charges seem fair and all parties did what they needed to do, but my own estimate was off by quite a bit. In talking with Aetna this morning, they said that the doctor, anestheiolgist, and hostpital could have submitted estimates that would probably have gotten me closer to the actual amount that I had to pay. So I have learned a lesson - if you are concerned about the final cost, talk to each provider and get the estimated costs to the insurance company in advance so that you can plan.
I gave feedback to the hospital and insurance company telling them that it should be easier to get an estimate but I wanted to get this information out in case it would help anyone that was arranging financing for a partial pay. Obviously if you are self-pay there are usually fixed price package and this doesn't apply. Likewise, if your insurance policy doesn't have a cap then you probably won't have as much of a surprise but it could still be more than you are expecting.
Hope this helps someone in the future. I'd like to state that this doesn't affect my satisfaction with my surgeon or the hospital who all did a terrific job and I wouldn't hesitate to recommend them or the sleeve to anyone. Even my insurance company was very helpful in understanding the outcome. This post is just intended to help people in their financial planning.
HW 420 SW 369 Pre-Op -51 lbs; M1-19;M2-15;M3-14;M4 -14;M5-13; M6- 14;M7-14;M8-10;M9-11;M10-11;M11-9;M12-7;M13-7;M14-5; M15-7; M16-8. M17-3. M18-6; M19-5. Goal of 200 (220 Lost) Reached Month 15. Goal of 180 (240 lost) reached at 18 months 10 days on 4/.20/13. 57% body weight lost@180. Now on maintenance. Low weight 169.
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