Insurance covers 50% -- what to do?

I have surgery scheduled for July 24. Ever since we scheduled surgery four weeks ago, I have been hounding my doctor's office trying to find out how much I owe and when.

Today, I finally speak to someone and they refuse to provide me a quote for the surgery or tell me how much I need to pay and when. They say that they won't know how much it costs until it's over and has been billed to the insurance company. They can't tell me the negotiated rate for the surgery.

How does anyone do this? My insurance covers 50% with no cap. It is outside my deductible system. So it's 50% of ... what? $50,000? $100,000? I need to know or I don't know how I can do this surgery. It could bankrupt my family. The hospital staff just said "You'll find a way to do this. If it's important to you, you'll make it work." 

That is a BS answer.  My doctor and the hospital gave me firm numbers up front.  My insurance covered 80% after a deductible.  Luckily, I have a max out of pocket of @2600.

Typically the surgery cost about 25k total in the US.  My insurance company covered 80% and the rest was on me.  I started receiving bills about 1 month after surgery.  In total out of pocket for me was about 2k.  I just send a payment in every month.

The day of surgery, I had to pay a 500 deductible.

I am in the same situation as you so I purposely went with the sleeve as they would only quote the total price for the sleeve and the band. The gastric bypass was a guessing game with them. At least $40,000 for just the surgery and then the hospital stay and everything else was additional. I have seen the charges for days spent in the hospital, that could lead to financial ruin very quickly. The sleeve price for everything, including the hospital, is $23,000. I had to have an actual number so I knew what my portion would be. You have to be firm with them. They should be able to give you the final number for the sleeve.

Good luck to you and I hope it all works out well!

You need to get the "codes" from the surgeon and hospital (the tricky part is they bill separately, and the anesthesiologist bills separate too...all mine came on one hospital statement, but there were 50+ different codes for all the things from the actual operation down to each pain med shot that I got).

The surgeon doesn't know what complications you may have, if you will be a 2 night stay or need longer, what if he has to convert to an open surgery b/c of some uncommon anatomy thing? 

I see why he can't give you a price.

You can get the common codes for the surgery and hospital stay, and with that info you can contact your insurance company to get the negotiated rates for each item, then add it all up.  total pain in the rump, but unless you find a surgeon that does a "package price" I don't know how you will get a number.

My total Bill for surgery, surgeon, anesthesiologist, and hospital stay, was $21,100+$4400 = $25,500 before the insurance discounted rates were applied.  I have all the codes they used on me, and if you want them, message me your email address.  I can send you a PDF.  You could at least see what the codes for the expensive parts translate to with your insurance.

It's so sad how we pay the insurance companies every month and they still can tell us what they will approve and how much. Hang in there and fight them. But if you do have to pay that much, have you ever considerd going to mexico to have it done? It was a great experience for me and the whole surgery was only $5500(including hotel afterwards) Good luck wth your decision. As long as you have your passport I'm sure they could get your surgery done around or on the date you are already scheduled for. Just a thought and a lot less money out of pocket! 

It makes me a bit nervous that the doctor's office seems to be dodging the question. They should be able to give you a quote for the procedure itself and explain that any additional services would cost extra. My doctor made it clear to me that they offer payment plans and could work with me to make everything affordable. 

I also have family that went from Canada to Venezuela to have the procedure done (they're originally from there) and it turned out to be much more economical. I wanted a more comprehensive plan and the peace of mind that my doctor was only 15 minutes away in case there was ever an emergency. But I have read several people have positive remarks about getting the procedure done in Mexico. Perhaps that's something you might want to look into. Best of luck to you - it is certainly an investment, but I think we all stand so much to gain from having it done.

My doc gave me a direct price up front so I knew what to expect. Also, when I went into the hospital for preop testing, they did the same. My insurance paid 80% and my total out of pocket was about $2500.