[NewMeNow2011]

I have UHC PPO Choice which has been great insurance except they have a clause in there, set by my husband's employer that is in regards to only bariatric surgery. They will pay 50% of my surgery, up to $15,000 and I can only have 1 surgery per lifetime. Because of this, I already had to put $5,000 down at the hospital and was told that the rest of my bills will be allowed to go into payment arrangements for afterwards (per the lady in charge of all of the insurance submitting at the bariatric side of my center/hospital). I spoke with their patient financial services and she said I could end up owing just a thousand or so more or $5,000 more, you never know. I had a bit of relief because I know the 50% will be on the ADJUSTED amount, not the crazy "$77,000" or "$57,000" etc that they initially charge insurance but the much smaller amount that insurance agrees on. Has anyone else had to pay 40 or 50% of their surgery? If so, were the expenses crazy? I'm having mine at a Center of Excellence but the hospital is a non-profit teaching hospital so it's the cheapest around (no AC even in our rooms!) so I'm hoping that helps keep the cost down!

[pretty woman]

I was billed $78,000 ( I think.) My insurance agreed to pay $15,000 and the hospital accepted that payment in full. So, perhaps you won't have to pay anything? I will keep my fingers crossed for you.

[MsVickie]

I hope your case turns out like Pretty Woman's. Its sad that the insurance company put that clause in there isn't it? Make me mad but they could have put one in saying they would not cover it and you would have had to pay out of pocket totally. I know insurance companies have contracts with hospitals. UHC is one that is not very popular where I live. Unless its a back up to Medicare not many family Drs offices will even take the insurance. Why? Because the reimbursements are so bad. Mine was paid great I couldn't complain one bit. I do hope that your bill for you to pay is small if not call the financial dept and work out something with them. I know I did one hospital and got off paying hardly anything. Keep us updated on this please.

[mj2903]

I also have United and mine paid 80% of everything (like other surgeries) except the anesthiologist. I also have the same clause as you. I have no idea why the anesthiologist was different but someone else I work with told me they paid 80% on all but one item and it didn't make sense which one.

Hopefully you will end up with the same results.

[NewMeNow2011]

I've already paid $5,000 so not paying anything won't happen A girl can dream, can't she? They almost gave me a heart attack and told me, right before my file was submitted to insurance, that I'd have to submit $5,000 more! But it turns out that lady had no clue what she was talking about! I have asked a lot of people what their 'adjusted amount' was on their bills, what insurance actually agreed to pay and usually it's like 12-15,000. One lady's insurance was billed $112,000 (she had a lot more than just bypass done because she had some internal things that needed fixed) and they adjusted it down to 16,000! I am hoping I know my insurance won't want to pay much so they are going to negotiate for themselves and that'll benefit me! I won't mind forking out a couple thousand more if I have to for it all, I know payment arrangements can be made and such, I've done it with other surgeries and we have saved like there's no tomorrow. I am very lucky to have such an amazing husband when it comes to supporting me in this!

Mel-- Your UHC had the clause that it'd only pay 50% ? Mine usually pays the normal 80% which is why this surprised me (and initially almost made this surgery impossible, luckily it's taken a year and we've saved and figured it out financially). They paid 80% of it though? That would be absolutely awesome! I won't get my hopes up but that would be amazing. Thank you for sharing your personal story with UHC!

[NewMeNow2011]

Originally Posted by MsVickie

I do hope that your bill for you to pay is small if not call the financial dept and work out something with them. I know I did one hospital and got off paying hardly anything. Keep us updated on this please.

Thank you Vickie I asked if I can make payment arrangements for the rest (I like to be prepared, especially when it comes to money) and I was told 'yes'. I've also told some people in financial services don't like to make payments for bariatric patients, siting it to be an 'elective surgery' which means people don't know what that term even means! There are only two kinds of surgery, emergency or elective. My gallbladder was scheduled so it was elective also, lol. A lady in financial services at the hospital told me I should be able to though, which seconds what I was originally told..so I am hoping that goes accordingly. I don't see why I wouldn't be able to, that'd be just silly! I'll keep everyone updated thank you!!!

[mj2903]

Originally Posted by NewMeNow2011

Mel-- Your UHC had the clause that it'd only pay 50% ? Mine usually pays the normal 80% which is why this surprised me (and initially almost made this surgery impossible, luckily it's taken a year and we've saved and figured it out financially). They paid 80% of it though? That would be absolutely awesome! I won't get my hopes up but that would be amazing. Thank you for sharing your personal story with UHC!

There were some fees that weren't covered but I really lucked out with what was in my contract vs. what they paid and if I hadn't heard from someone else that they paid normal on all but one item I would have thought it was a mistake.

I hope you get the same treatment!!

[NewMeNow2011]

Thank you, I hope so too! I won't count on it but that would just be awesome! I'll have to let everyone know how it goes

[tcgc0114]

I think my surgery was around $28,000 (before insurance settled). This was for LAP RNY. I was responsible for a $250 program fee owed to the surgeon and my $200 hospital co-pay.

Good luck on yours - I hope you owe nothing more!! (That would kill me, not knowing!)

[laughingpainter]

I had my 6 month appointment. I have 24 pounds left to lose I'm amazed that I've lost so much so quickly!
One thing that I've noticed though, being on the other side of heavy, the attitude of people that have known me before and see me now, they are envious and avoid me. It hurts that the people that i thought were friends and would rejoice with me at the triumphs can be as hurtful as those that did know me when I was heavy and treated looked right past me
I am living for me, I like the way i feel, and look, i am not going to change what I am becoming to suit them.
My Dr. has asked me to send pics of before and after, she wants to use them for others who want or need to procedure to encourage others that made me feel pretty darn good