Back to Self-Pay I Go

Well, as the title says, I'm back to self-pay.  I am now 200% sure my insurance only covers 50% of approved charges.  I'm not worried about the doctor's, anesthesiologist's, etc. approved charges.  They will be well under the cash pay price.  However, I have been told by the hospital that the approved charges for the sleeve gastrectomy are $20,000 plus.  I just couldn't belive that so I called my doctor's office to see if they could give me any insight.  I didn't tell them about my conversation with the hospital.  The insurance girl at Dr. Nicholson's office who has been there for "forever" told me that she recently had an experience with a gentlman who had the same insurance I did who was given the wrong information about his coverage like I was so many times.  However, he never got to anyone who clarified his benefits.  He only had 50% coverage like me and he ended up with a $20,000 bill at the hospital.  Since I'm getting very similar stories from both the hsoptial and the doctor, I think this information must be correct.  Therefore, my out of pocket would be more than paying the cash price.

Now, that being said, there are some advantages to cash pay.  The major one being I won't have to jump through my insurance companys "hoops" to get approval. 

So, here's to cash pay.

Protein Drinks

Ugh!  The thought of these just makes my stomach curl!  Anyone who knows me knows I am a SUPER PICKY eater/drinker.  I eat/drink NOTHING with any type of artificial sweetner in it.  I can't stand the stuff!  This part of this whole process gives me so much stress.  I've tried those premade Slimfast drinks--DISGUSTING!  I tried some other natural flavored protein powder that this nice lady at Vitamin Shoppe suggested--YUCK!  I've tried Chieke, two different flavors--Gross!  I've tried unflavored Unjury--It wasn't good either, but was the best of what I've tried so far.  I'm waiting on some Jay Robb powder I ordered the other day and the Syntrax Nectar I ordered tonight.  Please, please, please let one of those be better than the Unjury.  Otherwise, I'm stuck just having to hold my nose and get the Unjury down.  If there is a "bright" side to this, someone made a post about adding a drop or two of candy extract to the shake to help with the flavor.  I ordered several flavors of it too tonight.  ANYTHING to make this part of the process better.  I just wanna go to sleep two weeks prior to my surgery and wake up 6 weeks later so that I can begin using food (or at least maybe only 1 protein drink a day plus food) to get my protein in!  Anyone know if they make a pill for that?  He! He! 

~Amy

Insurance Ramblings

So, I originally thought my insurance would pay 100% of my WLS since my sinus surgery on April 11th will cover my deductible and, I expect, all of my out of pocket for the year. Then, I was told it will only cover 50% after I meet my deductible and that there is no out of pocket maximum. I'm still waiting on final confirmation of this but I suspect this is the case. Oh, and if I go with insurance, I have to have it at a Center of Excellence. Only hospitals qualify as a Center of Excellence. My doctor does the majority of his surgeries at at "outpatient" surgery center where you can stay confined for up to two days to help cut costs. If I have to have it at a hospital, my fees would greatly go up. The office told me I'd be better off paying their cash price ($12,200.00) then to file insurance because my 50% would definitely exceed the cash price being that the hospital fees are quite hefty. I kinda got it in my head that I'd be paying cash for the procedure but was still holding out hope I had better benefits than having to pay 50% of the bill.

Then today it happened. The lightbulb in my head turned on. I shouldn't have to pay 50% of the total bill. I should only have to pay 50% of the amount of approved charges by my insurance, right? Well, I called my surgeon's office and they were closed. Patience is not my strong point, so I decided to call another local doctor. The insurance girl there confirmed my thoughts. She told me my 50% of the physician's approved charges would only be around $500 to $600! OMG! That is great! Now, I know the hospital charges will be higher than the doctor's and thus a higher approved amount but it still shouldn't total their cash price of $11,900.00. The lady at the doctor's office didn't think so either but told me I'd need to call the hospital to verify. Unfortunately, they were closed for the weekend so the wait contines. One thing I do know though is insurance companies pay WAY under what doctors and hospitals bill. My sinus surgery physician's fee is over $11,000 but the approved amount is only a little over $2,000. It appears it will be that way with the WLS surgeon based on my conversation with a WLS office today. Therefore, I assume the hospital approved fees will be the same way. I can't wait to find out! So much so, I almost wish it was Monday now. See, I told you patience isn't my strong point. I'm just hoping I get to keep more of my money in my bank than I originally thought.

Woo Hoo! (I hope)