I Need Help with Everything

Okay guys I have been lurking around this board silently for over a month and I'm ready to jump in  and ask lots of questions. I have so many questions I don't know where to start so here goes. I just   got insurance approval this week for lap band and set a date of July 16th with my post op stuff being scheduled either the 9th or the 10th. My Insurance company is only going to pay half the cost of the  surgeeon fees I called my insurance company  and they hadn't gotten the autorization from the  percertification folks so they told me to call back  but that they I would have to pay a 100.00 outpatent fee. according to by benefits book Surgical procedures are limted to 50 percent of the allowable rate So does that mean that I'm going to get a huge bill from the hospital that I can't afford i'mhaving to scrape up the 1500.00 i have to give to my surgeon on my post op visit. My insurance company is managed through BC/BS  State employees inusurance board in Alabama.         

I don't know the answer to your questions about the insurance, but I did want to tell you congratulations on your upcoming surgery.  Also, please keep us posted.  We do care and would love to hear from you.  BTW...you have a great surgeon.  Welcome to the board.

i wanted to say congrats on your upcoming procedure and to say most of my fees from bc/bs were refunded after the hospital reviewed the records it took about 6 months but i got most of my out of pocket fees back

First let me say WELCOME!! I'm glad you posted and came out of lurker mode.  I honestly have no idea about the $$$$ questions. In fact, insurance policies and UCR (usual and customary rates) can be as different as two snowflakes.  What I think I would do is call the hospital and ask them what the full amount for the lapband is.  I went through St. Vincents East. I was private pay.  The cost for private pay was 5500 for MD services and 8000 for hospital. I believe the price I paid was the UCR that is allowed by most insurance. I DID get a bill for almost 30K from the hospital after my surgery.  I called and found out that they had erronously billed me. They wrote off anything above the private pay amount they received from me. So every story can be different. Again,I  would call your hospital for prices and keep calling your insurance company to verify information. Write everything down AND write the name of every person you speak with about this.   I had lapband in August '07 (ten months ago). I am down 70lbs so far. I feel great! It has changed my life and completely reversed my diabetes and other health related issues.  I pray that everything will go smoothly and successfully for you. Please keep in touch and let us know how things are going. We can always make room on the "losers" bench for more friends. God Bless, Nanci

Thanks to everybody who have replied I really appreciate the support I guess no matter how much homework you do there is always more. I just thought about this last night in the middle of the night what if I get the hsopital bill and its 10000.00 and I have to pay half then the surgery date would have to be put off I don't think I can handle that since I haven't been able to make myself cut back sicne I Foudn out that I now wegh more than I have in my entire life. I just go the percertification form out ot the mailbox and it  said mobid Obiesty so now it has really sunk in I have to get my weight under control for good. So I will be obsseing about cost once again until Monday am.and I can call BC/BS

No, you shouldn't. I too have the state employee's BCBS of AL and I know they paid all of my RNY costs. I did have to pay my deductible and $300.00 to my surgeon, up front, other than that everything else BCBS of AL paid in full, $32,000.00, 3 years ago. I also know the state employees BCBS of AL ( mental health division) will also pay for a tummy tuck and breast lift. I have many co workers who are post RNY who have had no problems in getting approval for these procedures so Im gearing up to get approved shortly myself. best wishes! I would call them Monday and just ask them, to be sure tho. Sandy

Thanks so much for your reply. Yes they pay all of the cost for RNY but not Lapband. which is a little discouranging  I have been praying all weekend that they will pay for all of the hospital except for the copay and the deductible. I wlll ******vous wrec****il I can call Monday am. thanks for the encouragement and good luck on the Tummy Tuck  

CONGRATS on your surgery!  I have BCBS as a state employee also, but I had RNY and all I paid was the hospital co-pay and Dr. Freeman's program fee.  I think my total was less than $1,000.  I'm over 4yrs post op, so things have changed, I'm sure.  Talk to Linda at Dr. Freeman's office and see what she can tell you.   Again, congratulations and keep us posted.

Thanks so much for the encouragement  Iwill be on the phone wilth BC>BC first thing Monday am.

Finally talked to BC/BS they said I would only have to pay my co pay of 100.00 so looks like i"m back on the only thing I have to worry about now is the bill for the anesthiea they will only pay 50 percent of that! thanks for replying I really appreciate it.