Blue Cross And Blue Shield insurance holders, HELP!!!!

I'm trying to choose a blue cross or blue shield plan that cover gastric bypass. PLEASE HELP ME!!!!!!!!!!!!!!!
What plan do you have, what percent did they cover for in-patient hospital, and how much did you pay OUT OF POCKET????????????????????????????????

please please please help me, i''m trying to choose one today!!!!!!!!!!!!!!!

I had Blue Cross PPO when I had my surgery.  There are all kinds of different plans within their system so I can't really say, but my maximum out of pocket for the year was $1500.  so no matter what, that is all I would pay no matter what happened.  I think I paid around 1200 total.

Good luck, Diane

You need to call them directly and ask, because each plan is going to be different according to the policy your employer has choosen.

First you may need to call your HR and get the group numbers for your plan.  THen call Blue Cross/Blue Shield....tell the customer service person that you are trying to choose a plan and what you plan to do. 

Take your time, take notes and if you do not understand what they are telling you it's ok! Ask them to slow down and explain it again. Good Luck!!!!

I have Anthem Blue Cross PPO.  My booklet says I will pay 10%.

Tatem....so nice to see you. I'm hardly ever around here myself, but was just checking in today and saw your post and decided to try to answer your question as it pertained to me. 

Anyway, I had Blue Shield POS through my job at the time.  It is a three tier plan.  I opted to use the HMO portion of the plan for my surgery.  It involved getting referrals as opposed to using the PPO and just choosing a plan doctor or going completely out of network.  I had to get approval from my health group as well as the insurance company itself.  Once all paperwork was submitted properly though, the referral/approval process went very quickly.  About 3 weeks total time.  My entire out of pocket for everything was $50.00 for a co-pay for my psych eval.  That was it.  Well worth it to me for a little inconvenience of getting referrals.

You need to look into whatever plan you are considering and find out exactly what they require.  Many insurance companies have different plans available and one plan may or may not cover what you want it to.  Read the small print carefully.  Don't assume anything unless you see it in print.  And don't think you can just call them and have them give you the info over the phone.  If you do that, be sure to have them follow up that information in writing.  Again, get everything in writing.

Good luck.  Don't give up.  You may have to "jump through some hoops" and do things that you think make no sense whatsoever.  But if you really want to have the surgery, then you MUST do what they ask of you.

Stephanie

BC BS PPO (Inland Empire)
I went out of network with Dr. Alan Wittgrove at Scripps in La Jolla.
It cost around $9K for my portion. He pioneered the lap method and was Carney Wilson's surgeon.

Each employer has a negotiatied rate.  So bottom line is......it depends on what plans your employer purchased (negotiated)  I happen to have BC Anthem HMO and my RNY was paid at 100%


Ask to see the evidence of coverage for the plans your eligible for and be careful to read the exclusions. 


Linda

If you can afford it go on the PPO plan. HMOs are evil and care more about money than do your health adn well being. I foought the HMO for over a year before I switched to a PPO. It took 9 days to get approved with the PPO. I was still fighting to get the referral from the HMO to the surgeon I wanted.

PPO is more money but gives YOU far more control over you health situations

I went to the local support group and asked who their primary care doctors were how refered to the surgeon I WANTED. Then called my BS HMO group and switched to that primary care so when the approvals were done I could do to my choice of surgeons. Worth the homework because I paid a big fat $5 copay for the office consults and followups. 100% covered with my policy. READ the fine print and make sure there are no exclusions. Check out my blog for a copy of the letter I used. Wish I had used if from day one and probably would have moved it along a bit sooner if I had done it from the start!

We have Blue Shield HMO, who happens to cover the medical clinic that I've gone to for over 20 years, so I've been able to keep my same doctors.  I had to be referred to the bariatric surgeon with the medical clinic, but he has a good reputation, so that was okay.  I paid only $100 for the operation itself, plus my $10 copay anytime I see the doctor.  Our first experience with Blue Shield had been pretty negative when we started it last year, but they sailed through approving the RNY without any hitches, hoops, or hoopla. -- Carol