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Anyone pay out of pocket?

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Old 05-17-2008, 05:08 PM   #1
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Anyone pay out of pocket?

After reading quite a few of the threads on this board I see that there is a BMI requirement and/or co-morbidities needed to get approval from your insurance.

I don't think I'll qualify. I haven't called yet but plan to on Monday.

Anyone pay completely out of pocket? How much (if I can be so blunt)?
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Old 05-17-2008, 05:40 PM   #2
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I did not get any support from my insurance. They flat out said no coverage for bariatric surgery no matter what. I paid $7,000 and had it done in Mexico with Dr. Zapata in Monterey. It was an awesome experience.
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Old 05-17-2008, 05:48 PM   #3
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Most insurances, if they cover it, require a BMI of 40 or will do it if it is above 35 with 2 co-morbities (e.g. high BP, cholesteral, diabetics etc). My BMI is 32 and I paid for my surgery this Friday, getting it done next Thursday. When I think of what I have spent on personal trainers the last 3 years, diets, doctors, nutri-system, etc., this is going to be cheap
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Old 05-17-2008, 06:22 PM   #4
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Quote:
Originally Posted by Demeter View Post
After reading quite a few of the threads on this board I see that there is a BMI requirement and/or co-morbidities needed to get approval from your insurance.

I don't think I'll qualify. I haven't called yet but plan to on Monday.

Anyone pay completely out of pocket? How much (if I can be so blunt)?
I am paying $18,000.
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Old 05-17-2008, 07:01 PM   #5
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$16,000 out of pocket in Ontario, Canada.
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Old 05-17-2008, 07:11 PM   #6
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hey. It really depends on your insurance company, and sometimes your employer, who can choose to exclude the benefit from the policy. Absolutely call your insurance company and ask them. You may want to have the procedure code (from surgeon) to give them. Many are seeing the light and realizing that this is curing much bigger and more expensive illnesses down the line. Mine did, BCBS, and they are paying 90%. I hope it all works out for you! Never give up. Best Wishes
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Old 05-17-2008, 08:12 PM   #7
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hi
i paid $12,900 in texas. this included 1 year of doctor visits and fills/unfills.

each person's insurance depends on how their employer set up the plan. it is not decided by the insurance company.
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Old 05-18-2008, 10:36 PM   #8
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My husband hopes to have his surgery soon.
We decided after having a terrible experience dealing with the bariatric coordinator in Peoria, IL that we would just pay out of pocket for him rather than go to SFMC where he would be covered.

Here is what we have found in central IL:
Galesburg - Cottage 38000
Moline - Trinity 16000
Peoria - Methodist 12000
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Old 05-18-2008, 10:39 PM   #9
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Dr Tom Brown, DEnver $9,900 and Dr Kishbaum, Denver $9,900. DEnver is pretty reasonable comapred to other parts of the country
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Old 05-26-2008, 03:44 PM   #10
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Has anyone paid an extra ~3500 for their pre-op tests (EKG, chest x-ray, etc.)??? I just got a bill from my hospital for that much--and they want my self-pay $11,000 next Thursday!
The original quote for my self-pay surgery is 11000 for the hospital, 5000 for the doctor's fee, and 1000 for anesthesia... for a total of $17,000. But, if these pre-op tests aren't covered, that makes the total $20,500.

Please help!!!! Poor student living on loan money...
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Old 05-26-2008, 04:04 PM   #11
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i paid $17,300 at Northwest Weight Loss Surgery in Everett Washington. That includes fills for 1 year, and any surgery that might have to be done if anything goes wrong for 2 years.
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Old 05-26-2008, 05:14 PM   #12
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I, too, paid out of pocket. June of 07, yes 1 year now.

Mine was all inclusive at $7,000.
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Old 05-27-2008, 03:49 PM   #13
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I'm self-pay because my insurance has a bariatric policy exclusion.

Doctor's surgery fee is $6,000
Hospital fee is $11,000
Program fee is $550
Pre-op visits, consults, and tests: so far, over $5,000(!) luckily, my insurance picked up most of that.
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Old 05-27-2008, 04:15 PM   #14
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I paid 14,000 in North West Louisiana. I have Aetna who requires a BMI of 40 for 5 years along with 2 co-morbidities uncontrolled for 5 years. My BMI was 38.4 just began B?P meds that controlled B/P. Hubby and I decided to pay and bypass the co-morbidities that were sure to come. Good luck in your quest whether you or your insurance pays.
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Old 05-28-2008, 09:31 PM   #15
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I paid $17,300 cash. that included all the pre surgery testing and all fills for one year and never have to pay for visits again no matter how many times I go for appointments.
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