Hi - I'm new to this forum, posting this here for feedback:
After 4 months of ridiculous back and forth, miscues (on their part), peer to peer reviews with my surgeon, adding documentation, etc., my insurance (BCBS of IL) has now denied my (1st) appeal for band removal/revision to DS surgery. Their primary reason: not medically necessary as my BMI is not 50 or over (it’s 35). The clinical documentation of severe bile and acid reflux and history of bile aspiration while sleeping (due to the band) was not compelling to them apparently.
So l’m contemplating self-pay. But, my very well respected and recognized-expert-at-DS procedure surgeon is wickedly expensive compared to other self pay quotes I’ve seen others post.
All in he is saying total cost for band removal and DS will be somewhere around $40K. I know could save a ton of money if I travel to another doctor…..but I feel so strongly that I want MY surgeon to remove the band bc he’s the one that put it in, a million years ago. And I trust him implicitly. What would y’all do? Should I try to negotiate with him to bring his self-pay price down? He’s trying to convince me to have it done in an outpatient center vs a hospital, bc he says he can get me the best price that way. Thoughts?!?
After 4 months of ridiculous back and forth, miscues (on their part), peer to peer reviews with my surgeon, adding documentation, etc., my insurance (BCBS of IL) has now denied my (1st) appeal for band removal/revision to DS surgery. Their primary reason: not medically necessary as my BMI is not 50 or over (it’s 35). The clinical documentation of severe bile and acid reflux and history of bile aspiration while sleeping (due to the band) was not compelling to them apparently.
So l’m contemplating self-pay. But, my very well respected and recognized-expert-at-DS procedure surgeon is wickedly expensive compared to other self pay quotes I’ve seen others post.
All in he is saying total cost for band removal and DS will be somewhere around $40K. I know could save a ton of money if I travel to another doctor…..but I feel so strongly that I want MY surgeon to remove the band bc he’s the one that put it in, a million years ago. And I trust him implicitly. What would y’all do? Should I try to negotiate with him to bring his self-pay price down? He’s trying to convince me to have it done in an outpatient center vs a hospital, bc he says he can get me the best price that way. Thoughts?!?