HELP..I need BC/BS Info-Dr. Schmitt

I am searching for anyone that has Alabama BC/BS (PPO) Insurance. I just got back from my first visit at Dr. Schmitt's, which did not involve him and discovered no one could tell me an AVERAGE cost to me for the surgery, excluding the amount BC pays. I realize it can't be quoted to the penny, but, just a range would have been  nice. $500 to $5,000... anything! I was told by the insurance clerk (?) that she couldn't tell me anything. So, after the receptionist acted like an ass ,and Ididn't get to see the actual doctor that will go inside my body, and was interviewed for 5 minutes by a nice nurse (she simply read what I had written back to me on the health information form.. and read some of it wrong!) I am saddened to say I walked out in frustration. I don't know what to do now.. I had my heart set on this surgery in St. Vincent's by Dr. Schmitt. Sometimes you get a bad, weird feeling about things and I got a serious one this afternoon in that office. Has anyone else had that experience? Thanks!

Girl Don't do this LOL I have an Appt with Doc. Miles  Monday The insurance part ? I am on Medicare Insurance. All They did was go over ur  Medical Papers . Did you have to pay today?  All I Have heard from them is Good

You have a PM.

My experience with them was good.  Regarding insurance, I worked for a doctor years ago while in college and  then became a  benefits coordinator/human resource manager for a large manufacturing company before going back to grad school. They are correct in saying that there is NO WAY they know how much your insurance will pay.  Your policy is a written agreement between your employer  (or whomever your insurance is through) and BC/BS.  There could be diffferent exclusions, deductibles, rates, etc, etc,  that were established by your employer with BC/BS  PPO.  The only one who could give you some kind of idea as to what will pay or not is your insurance company.  And even then, don't be surprised if you hit a brick wall simply because some PPO policies have UCR (usual and customary rates) negoiated with the service provider. So it is not the doctor's  office fault for not knowing. As far as the cost of surgery, I was private pay and paid $8000 to the hospital and $5300 to the MD.  I have BC/BS  PPO also but my policy will not cover ANY WLS or procedure but I knew this going into it.  Sometimes making exclusions and higher deductibles help sway the overall cost of the insurance in order for the employer and employees to afford it.  I did get frustrated with St. Vincent's East when I received a bill for almost 30K then started receiving collection letters when I had paid cash for the agreed amount for my lapband. But Dr. Miles/Schmitts office cleared it up for me.  I think if I had a weird vibe going into it, I would probably look at my options.  Deciding to get WLS is already eventful and stressful enough but it helps when you can feel 100% confident about all aspects of it.  Good luck with everything. I love my LAPBAND and feel great! Nanci

I have BC/BS of Alabama PPO.  My policy pays 50% of the surgeon fee.  So i paid Dr.Sherer 1106.00 for his part.  I paid the hospital $100 Deductible and $15 a day co pay.  When i got my statement from BcBs it said the grand total was 25,600.  I hope that helps you.

As stated and spoken to you... all policies are different but I COMPLETELY understand your frustration. I went through the exact same thing. Noone would tell me anything... the surgeon's office or the insurance.. So I'll tell you my experience.. based on my policy.  I have BCBS PPO and used Dr. Miles. My policy states that they will pay 80% for the surgery, surgeon, and anesthesiologist (SP)  The charges were -  Dr. Miles - billed $3500 - BCBS allowed $2114 - I paid $422.80 St. Vincents - billed $28986.00 - BC allowed $7536 - I paid $150.00 (my op surgery copay)  I hope this helps!  You can look at your policy online or in your benefit packet. If you need help doing that, let me know.

Thanks for the help and advice...I appreciate it. I do know that Dr. Schmitt is a good LapBand Surgeon, or I would not have selected him to begin with. But, my office visit was not as supportive/informative as I expected. And I will say again, I know they can't give me an amount to the penny, but, a round-about AVERAGE amount with a high and low, would have been helpful. Procedure charges reflective of my insurance and surgery go through their office many times and I felt like someone could tell me something. That said, I am happy for the people that have had a successful experience with them and I expected to be included in that group, but, that will won't happen. I will however search for an alternative. Thanks again for the info!

FYI... after so receiving many replies from this board from peopele with similar cir****tances on surgery costs after BC/BS pays, I am back with Dr. Schmitt. I am able to live with the estimated cost information I received from emails and posts; thanks to you all. I feel better not going into it blindly with no idea. I talked with Naomi at the office and I will go by to see her and finish up my paperwork. I am excited and scared and ready to complete my six month... or five month, now- requirements for surgery. What a load off of my mind.. I feel better already!

HI! I'm glad you are feeling a little more comfortable with Drs. Schmitt and Miles. Like I previously stated, my experience was great.  Naomi was extremely nice and helpful. I think you are in good hands. Getting the band or having RNY can really be stressful, exciting, unpredictable, and scary all at once. For me, it was all those things and similar to when I was pregnant and nearing my due dates.  I counted the days off until my appointment then counted the days off until surgery. I even gave myself a party to my "old" ways or pre-band body a few weeks before my surgery.  I think I consumed more Krispy Kremes, Outback cheese fries, and all the other no-nos that got my body in the shape it was in. That was not the healthy thing to do BUT...I'm glad I did it because I cannot fathom my old habits and the thought of eating more than a taste of KK donuts makes me  now. So, I'm glad I said my good byes to those things and I welcome the new me and the new way of life. It will pass before you know but remember, you may experience a variety of emotions. It's just all part of the ride.  Good luck and keep in touch. Nanci