So, after finding out that the operation would be at least twice what I was quoted in the information session I was upset. Really upset. I cried, swore, and felt exposed and raw. Here I had gotten my courage up to do this life changing operation and it felt like I was the victim of a bait and switch attempt. However, I am no victim. I decided to call my insurance company and tell them what I was told - maybe they could explain it (they couldn't) and then I decided it was time to do some comparison shopping. I have two other hospital systems as in-network on my insurance plan. The well-respected teaching hospital let me down, but there was the world-reknown hospital and the smaller Catholic hospital to go check out. Next up, world-reknown!
I checked out their bariatric center website online and it looked about what I've come to expect - although they offer a fourth surgery as well, where the stomach is folded in on itself and stitched shut. I suspect that wouldn't reset the hormones to signal the pancreas to reverse diabetes, but I'll find out at the information session. Yup, another information session. But this time, I called the financial counselors before going to the info session. Bariatric Betty has picked up a few things...
So, after having a hard time reaching the financial counselors via phone, I used their email and got a response almost immediately. Hospital B said the average total cost of a gastric bypass is $40,000. Ouch again. But, this estimate included pre-surgery studies (sleep and ekg, labs, etc), the facility charges, plus the surgeon and the anesthesiologist! I detailed all that out in my email requesting the info. So hopefully, the pre-surgical expense part of that will be outside my $15,000 cap. It feels a lot better knowing a total figure. Here's the downside, and why it's important to talk to your insurance:
Hospital A estimates the cost to be $40,000, plus surgeon, plus anesthesiology (two unknowns they wouldn't estimate). My insurance contracts with them at a 66% reimbursement allowable, which means that the hospital will accept $26,400 as payment in full. Subtract the $15,000 cap and I would owe about $11,400 plus the surgeon and anesthesia.
Hospital B estimates the total cost to be $40,000 (including the surgeon and anesthesia). My insurance contracts with them at an 80% reimbursable allowable, which means that they will only accept $32,000 as payment in full. Subtract $15,000 cap and I am left paying up to $17,000. At least that estimate includes everything.
I contacted Hospital A's bariatric center coordinator to tell her I was considering going elsewhere for my surgery and how upset I was about the discrepancy in the costs between their financial person and the information session. She seemed genuinely surprised and concerned at the discrepancy as well and promised to get to the bottom of it. She asked me for a few days to figure out what's going on before I make my decision, which I agreed to because it will take me longer than that anyway. She said they will get back to me with the total amount I would pay for everything after talking to my insurance and the finance people.
Meanwhile, I've got the information session for Hospital B tomorrow night. The fun continues...