Financial Breakdown for Patients WITH Out of Network Benefits
It’s important to understand that although Maryland Bariatrics is not in network with your insurance, the Hospital, Anesthesia, and Pathology providers ARE in network with your insurance. Therefore, the majority of your surgery WILL be covered as in-network. Only the surgeon’s fee will be billed as out of network. We will clearly state all of the charges from Maryland Bariatrics before your surgery.
Breakdown of Costs and Reimbursement:
Program Fee: $360 (This is not covered by insurance, and cannot get reimbursed)
Initial Consult: $215
Weight Management: $90 each
Final Pre Op: $145
All of your office visits will be billed to your insurance company. Since you do have out of network benefits, you can expect your insurance to reimburse you directly. If your insurance company should send a check to our office, we agree to reimburse that amount to you in full.
Surgery Costs:
$4,900 Sleeve Gastrectomy
$6,200 Gastric Bypass
$6,900 Duodenal Switch
We will credit all of your payments from the program fee, consultation, and office visits towards your surgery costs.
For example, if you had 4 weight management visits, you would have paid a total of $1,080 between the program fee, consultation visit, weight management, and final pre-op appointment. If your surgery cost is $4,900, your remaining balance for the surgery would be $3,820.
Our team will then bill the surgery claim to your insurance as an out of network provider, and you will receive the reimbursement from your insurance company.
As an office guarantee, we provide 3 months of follow up visits after surgery at NO COST to you!! Additional follow up visits after 3 months are $75 each.
EXAMPLE
Patient: John Doe
Insurance: CareFirst
Out of Network Benefits: 80%
Weight Management: 6 months/ 6 visits
Program Fee: Mr. Doe pays $360
No claim is submitted to insurance
Initial Consultation: Mr. Doe pays $215
CareFirst sends a check to Mr. Doe for $172
Weight Management: Mr. Doe pays $90 at each visit
After each visit, the insurance sends a check to Mr. Doe for $72
Final Pre Op Visit: Mr. Doe pays $145
Insurance carrier sends a check to Mr. Doe for $116
Mr. Doe’s out of pocket surgery cost is $4,900.
He has already paid $1,260 towards his program. That is applied towards his surgery cost.
Remaining balance for surgery: $3,640
After Surgery, the insurance sends a check to Mr. Doe for $3,920
(80% of the total $4,900)
Mr. Doe will then receive 3 months of follow up care at NO COST, If he needs more follow up visits after 3 months, it will cost $75 per visit.
Total amount Mr. Doe paid for surgery: $4,900
Total amount Mr. Doe received from his insurance: $4,640
**The amount reimbursed to you by your insurance is dependent on your individual plan and coverage. It is subject to deductible and out of pocket maximums as outlined in your insurance plan benefits.
