Hello, I would like to have some clarifications on the out of pocket costs for a patient that decides to have two concurrent surgeries, only one of which is covered by insurance.
In my case, I need to have a hiatal hernia repair surgery, which is covered by my insurance, and I have been considering coupling it with a concurrent bariatric surgery (sleeve gastrectomy) which has been recommended to me to mitigate my hypertension and sleep apnea conditions and prevent a potential onset of diabetes. The problem is that my BMI is not above the limit of 35, which is the threshold required by my insurance to approve the surgery.
Besides the obvious advantage of being cut open once instead of twice, my thinking was that a concurrent surgery would significantly lower my out of pocket cost for the non-covered surgery with respect to have it performed "as standalone". In other words I thought that the only relevant out of pocket cost would be the bills of the doctors performing the surgery because the facility cost and the anesthesia cost would not be significantly increased by the addition of the the second procedure ( just the incremental cost for the longer use of the surgery room and the personnel in it), and hence they would be essentially covered by the insurance payment for the covered surgery.
Instead, I was given a financial estimate in which the out of pocket savings that I would receive by the concurrent procedure are very marginal (about $500 on a total cost of $20000).
My questions are:
1) Is it standard that facility and anesthesia costs are basically doubled when one has two concurrent procedures? After a little research my understanding is that, if both procedures were covered, the insurance would reduce even the surgeon fee for the second one by 50%. I would assume that the reduction would be even larger for the other costs, but I was not able to find any info in that regard. In other words, is this a "legitimate charge" or am I been taken advantage for "stepping out of the protection of the insurance"?
2) Even worse, how likely is that I am being charged much higher facility and anesthesia costs for the out of pocket procedure than those contracted by the insurance for the covered surgery?
I apologize for the long post, but I would highly appreciate any help in understanding this issue. Thank you
In my case, I need to have a hiatal hernia repair surgery, which is covered by my insurance, and I have been considering coupling it with a concurrent bariatric surgery (sleeve gastrectomy) which has been recommended to me to mitigate my hypertension and sleep apnea conditions and prevent a potential onset of diabetes. The problem is that my BMI is not above the limit of 35, which is the threshold required by my insurance to approve the surgery.
Besides the obvious advantage of being cut open once instead of twice, my thinking was that a concurrent surgery would significantly lower my out of pocket cost for the non-covered surgery with respect to have it performed "as standalone". In other words I thought that the only relevant out of pocket cost would be the bills of the doctors performing the surgery because the facility cost and the anesthesia cost would not be significantly increased by the addition of the the second procedure ( just the incremental cost for the longer use of the surgery room and the personnel in it), and hence they would be essentially covered by the insurance payment for the covered surgery.
Instead, I was given a financial estimate in which the out of pocket savings that I would receive by the concurrent procedure are very marginal (about $500 on a total cost of $20000).
My questions are:
1) Is it standard that facility and anesthesia costs are basically doubled when one has two concurrent procedures? After a little research my understanding is that, if both procedures were covered, the insurance would reduce even the surgeon fee for the second one by 50%. I would assume that the reduction would be even larger for the other costs, but I was not able to find any info in that regard. In other words, is this a "legitimate charge" or am I been taken advantage for "stepping out of the protection of the insurance"?
2) Even worse, how likely is that I am being charged much higher facility and anesthesia costs for the out of pocket procedure than those contracted by the insurance for the covered surgery?
I apologize for the long post, but I would highly appreciate any help in understanding this issue. Thank you
