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Thread: Self-Pay Hell!

  1. #1
    Gastric Sleeve Member sraebaer's Avatar
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    Default Self-Pay Hell!

    So I had my surgery over 5 years ago. My insurance, Blue Cross/Blue Shield, would not pay for bariatric surgery, period. So I was self pay. I knew going in that if I had any complications my insurance would not pay a thing. I was lucky, everything was fine.

    Until now, this time my PCP must have coded my yearly blood work as "bariatric surgery." So I ended up with a $900 bill!! OMG. Be so thankful if you have insurance. (The blood work came out fine.)

    I'm trying to fight if, but know from experience fighting an insurance company goes nowhere. They are the devil. I'm on 4 medications, and the blood work is to see what these meds are doing to my body. I know my cholesterol med can damage my liver. It has nothing to do with weight loss surgery. That is ancient history.

    I also had to pay $2,000 for the ambulance when I broke my neck 2 years ago, because I used an "out of network" ambulance. However only ONE ambulance service enters our neighborhood. I fought that forever, but ended up paying. Next time someone is seriously ill, we will get in the car.

    Rant over.



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  4. #2
    Gastric Sleeve Member Sandra3's Avatar
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    Default Re: Self-Pay Hell!

    The rant is really justified!!

    We lived in many different countries over the years, and for sure the medical billing system in the US was the most complicated (and crazy expensive!)!
    Our French insurance had a contract with an American office, but at the end, I was getting a better deal from doctors negotiating directly the price myself!

    I mean 900$ for blood tests? unless it's genetic testing, there is no way it should cost that much!
    2000$ for an ambulance ride?? it's like ten times what it cost in other countries!

    I do understand that all the medical is a business, but those crazy prices put people's safety at risk, because they will go without needed services since it's not affordable!

    When I was at the hospital two weeks ago, I saw a patient, who was not even injured and was very able to walk, using a "free ambulance" to go back home.
    He was in the same ward I was, for tests (we talked in a waiting room), so I didn't understand why on earth he would be able to ask for transport!!

    Apparently, from what the nurse said, "it's available each time you leave the hospital". I was so shocked...what a waste of the tax payer's money!

    I never ever used those ambulances, even after surgeries, even when I was incapacitated, I always managed to go back home with my husband driving our own car!
    I always thought that only people really disabled should use those, because they do need it. Or senior citizens who don't have any one to drive them, and have issues walking...

    Apparently the nurse told me everyone is using it...this is so ridiculous!! what a shame our resources are wasted for no good reasons.....


    HW : 150 kgs
    09/02/2014 : 142 /1st apt
    01/20/2016 : 134 /surgery
    01/30/2016 : 130 /1st post-op
    02/27/2016 : 126 /2nd
    04/23/2016 : 118 /3rd
    07/16/2016 : 109 / 4th
    10/01/2016 : 103 /5th
    01/21/2017 : 98 /1 year post-op
    February 2017 : 100 lbs lost
    07/22/2017 : 96
    10/21/2017 : 93
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    01/02/2018 : 96!! regain (medication)

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  6. #3
    Gastric Sleeve Member AnnieG's Avatar
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    Default Re: Self-Pay Hell!

    Quote Originally Posted by sraebaer View Post
    So I had my surgery over 5 years ago. My insurance, Blue Cross/Blue Shield, would not pay for bariatric surgery, period. So I was self pay. I knew going in that if I had any complications my insurance would not pay a thing. I was lucky, everything was fine.

    Until now, this time my PCP must have coded my yearly blood work as "bariatric surgery." So I ended up with a $900 bill!! OMG. Be so thankful if you have insurance. (The blood work came out fine.)

    I'm trying to fight if, but know from experience fighting an insurance company goes nowhere. They are the devil. I'm on 4 medications, and the blood work is to see what these meds are doing to my body. I know my cholesterol med can damage my liver. It has nothing to do with weight loss surgery. That is ancient history.

    I also had to pay $2,000 for the ambulance when I broke my neck 2 years ago, because I used an "out of network" ambulance. However only ONE ambulance service enters our neighborhood. I fought that forever, but ended up paying. Next time someone is seriously ill, we will get in the car.

    Rant over.
    Sraebaer, PM me if you want some assistance -- I've had great success getting things overturned and approved for various conditions and for many friends over the years. (Working in mental health the insurance is so picky and weird that you get lots of skills to be able to see your clients). Not that I don't think you can do it, but it might help the stress! Mine was self pay, but I have had no issues with the follow up. It's all about the coding.
    [I]HW: 240 lbs CW: 205 lbs: SW: 199 lbs GW: 130 lbs

    1 MO = 167.0 2 MO = 156.4
    3 MO = 148.4 4 MO = 140.6
    5 MO = 136.0 6 MO = 130.0 (GOAL)
    1 YR = 122.0 20 MO = 130.0

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  8. #4
    Gastric Sleeve Member Katrina's Avatar
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    Default Re: Self-Pay Hell!

    Thank God our insurance has covered everything since surgery. My daughter's hospital stay was still tens of thousands of dollars even after insurance covered most. Her 3 day stay over Christmas 2015 before she got REALLY sick was $14,000, and they literally did NOTHING for her. She is now on Medicare due to her disability. I'm so thankful she was on her dad's insurance during the 2 year gap period until she could get Medicare. I, so far, havent had to pay anything above normal for any of my bloodwork and such.

    I hear people are now using Uber to get to the hospital instead of calling an ambulance. That's really sad it's come to that.

    I hope you're able to get the charges reversed. Do they not realize how much money they're saving because you paid out of your own pocket to get yourself into a healthier place? They could be having to pay for obesity related illness, but instead are punishing you for getting healthy. Fools!
    No pre-op diet
    Day of surgery 11/4/14: 5'4" 213lbs
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    3 months: 155
    4 months: 148
    5 months: 142
    6 months: 136
    7 months: 131
    8 months: 125
    9 months: 120
    10 months: 114
    11 months: 111
    1 year: 109
    1.5 years: 105
    2 years: 108
    2.5 years: 102
    3 years: 113
    4 years: 115


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  10. #5
    Gastric Sleeve Member kenson's Avatar
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    Default Re: Self-Pay Hell!

    So ridiculous! Keep fighting!! Last summer, I had a little "episode" in a restaurant. An ambulance was called, but I was fine by the time they came. The ambulance service still charged me $150 because they were called.



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  13. #6
    Gastric Sleeve Member Ann2's Avatar
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    Default Re: Self-Pay Hell!

    Sharon, I'm really sorry. I'd take up Annie on her offer. She's been through a LOT on the medical and insurance fronts.

    And Katrina -- that's a GREAT tip re getting Uber to take you to the ER. Really smart.

    Final thought: You're going to LOVE Medicare! Easiest, sanest and best medical insurance I've EVER had.



    Consult: 235 lbs
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  14. #7
    Gastric Sleeve Member Stacey03's Avatar
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    Default Re: Self-Pay Hell!

    Gahhhhhh how annoying! Your medical system is insane! Get Queen AnnieG on the case :-)


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  16. #8
    Gastric Sleeve Member sraebaer's Avatar
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    Default Re: Self-Pay Hell!

    Quote Originally Posted by Ann2 View Post
    Sharon, I'm really sorry. I'd take up Annie on her offer. She's been through a LOT on the medical and insurance fronts.

    And Katrina -- that's a GREAT tip re getting Uber to take you to the ER. Really smart.

    Final thought: You're going to LOVE Medicare! Easiest, sanest and best medical insurance I've EVER had.
    Three more years till Medicare. Looking forward to something sane.

    That Uber idea is great, unless you have a broken neck. I remember my mom was so upset about an ambulance bill that the next time she had an A-fib episode she drove herself to the hospital. The hospital was only a mile from her house. They yelled at her, but she was happy to have saved the cash!!



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  18. #9
    Gastric Sleeve Member KiwiGal's Avatar
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    Default Re: Self-Pay Hell!

    Gosh hearing all these stories I'm glad that I live in little ole NZ.
    We have a "free" ambulance system. They do send you an invoice afterwards - but you only have to pay if you are able to afford it and it is usually something like $80NZD. Or you can pay a yearly subscription ($50) and all trips are free. We did this for my parents as they were always in and out of the hospital. Was definitely worth the $50!
    Public hospitals are free too but there is a waitlist - unless you are really ill and then you go in straight away. Dr's we pay for - unless you qualify for free treatment and if you want to go private (as I did with my surgery) then you definitely pay - unless you have good health insurance.



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  20. #10
    Gastric Sleeve Member Christie13's Avatar
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    Default Re: Self-Pay Hell!

    Boo!! That really stinks. Hopefully your doctor will recode it for you.



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  22. #11
    Gastric Sleeve Member sraebaer's Avatar
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    Default Re: Self-Pay Hell!

    My doctor has re-submitted everything. Hope for better results this time.

    Makes me question HIPPA, I paid for my own surgery and didn't want my insurance company to know I even had it done. But of course the hospital puts it on my chart for every doctor or insurance company on the planet to see. Doesn't seem right.



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  24. #12
    Gastric Sleeve Member Dutchie's Avatar
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    Default Re: Self-Pay Hell!

    I have no clue how this works in the US, but I sure hope things will work out for you!
    English is not my first language, so I may and do make mistakes in my spelling, or say things oddly. Please ask me, if you want any clarifications.



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