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karinmaxim | Do some bariatric programs charge over and above what Blue Cross Insurance will pay? |
I have a sister in law and a family friend who had bariatric surgery other than small co-pays they were not billed additionally-but the surgeons office at Barix Clinics says before surgery can be scheduled they want me to come in to discuss "money". I told them i believe Blue Cross will pay in full- What's going on? |
 |
 
mbrcatz
 |
Blue Cross has tons of different plans, and what is covered varies plan by plan, and state by state.
If you think BC pays in full, what's it going to hurt to discuss money with them?
MOST of the time, this isn't covered at all. When it IS covered, most of the time, you have a 20% copayment, and possibly a deductible as well. |
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Custo
|
You'll probably need to clarify with them... Its possible they're not on the insurance. If they are out of the network, they will be paid based on an allowed amount, determined by the insurance carrier. It may be less than the amount they bill. If they are out of the network, they may bill you for any services above what the insurance pays. They may be providing services the insurance won't cover... There are lots of legitimate possibilities.
If they are contracted with the insurance, they shouldn't need anything except your copays.... So, be careful what you pay them. Its hard to get refunds from doctor's and hospitals. |
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meka64_2003
 |
people who are interested in biatric surgery need to be aware of the complications with are associated with it. Although it is very possible to lose a significant amount of weight through biatric surgery, it is important to have realistic expectations for weight loss goals. Majority of the time, patients do not reach their ideal weight even after the procedure. Those who have a lower BMI have a tendency to lose more excess weight and those who have a greater BMI tend to lose more total weight. People who look at biatric surgery as a way of improving their quality of life and overall health tend to have the most success in the long run. So, cost wise, choose the best possible surgeion with the longest experience. Price shouldn't matter, your health is irreplaceable. |
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zippythejessi
 |
Most insurance companies consider Bariatric surgery cosmetic, and don't pay for it at all. Your sister-in-law and friend must have had someone go to bat for them to get it deemed medically necessary. (Either that, or some kind of miracle happened!) |
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Dawnita
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this is fairly common practice for any procedure that is rather pricey. Blue Cross Blue Shield will not pay in full, they are going to leave a co-pay and the drs office has to ensure that they will get that amount from you. They are more than likely going to want to set up payment arrangments for your estimated out of pocket expenses. Also keep in mind this will be for the surgeon only, not the anesthesiologists, hospital, and so on and so forth. |
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mommomleen
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As long as the procedure is considered medically necessary and the provider is in Network the surgery should be covered with only your copay/coinsurance as your liability. |
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