Hello...and help!

Hello there,

New to the forums but I have a ton of questions.  I really want to get the surgery but - from my calculations under my insruance; at the center of excellence; with the surgeon who takes my insurance - I'm looking at $13,000.

Questions:
Does anyone have Anthem Blue Cross PPO Share 5,000?
Has anyone gotten their surgery done at Good Samaritan Hospital?
What did you have done? How much was the bill (before/after insurance)
Is there a Blue Cross plan out there that I can change to that would make it less out of pocket for me?
Should of asked this first - but where's the "Insurance for Dummies" board? ;)

Many thanks in advance for your advice.

Hi there.  While I didn't have my surgery at Good Samaritan or have Blue Cross PPO, I do benefits for a living.

First of all, to change plans, if you are covered by an employer plan, it has to be open enrollment or you have to have a life changing event.  Most HMO's require less out of pocket than the 13k you are looking at with the PPO.  PPO's offer flexibility but generally cost more out of pocket unless you are married and you are covered under a spouse's plan that allows a sharing of benefits.

I am happy to help but need to know a little more about what plans your employer offers.

Thanks,
Barb

Go for an HMO. I paid $0 for my surgery (except $8 to park!)

Seriously!! That's simply fantastic.  Can you tell me about your experience? What hospital/surgeon, what was the process like, etc.

Thanks!

Hello, 

Yes, I have Anthem Blue Cross PPO through my husband and I did have to pay a share of cost around $5,000. I had surgery one year ago. My RNY surgery was at Orange Coast Memorial Hospital through Dr. LePort's office. My doctor is Dr. Kelly Francis and she is great.
 
Not sure if I can be of any more help because I dont know much about insurance plans.   We saved up for a year to afford my surgery.

Best wishes,
Amy

Welcome!

I had Kaiser so am no help there.
But I am in the Good Sam area if you need a friend !

Many thanks Cindy :)  I'm loving all the support from the forums so far.  Thanks to all! :)

I have Anthem Blue Cross PPO Premier; they covered my surgery, and informed me that I had to have it at a CoE (so I did have surgery at Good Sam in San Jose).

What about a program fee with the doctor's office?  The one I called had a $5,700 program fee - and others I'm seeing are anywhere from that down to $1,000.

Ah yes, I'm assuming that the $5,700 program fee is either my surgeron (Cirangle) or his partner (Josset).

I had to pay that out of pocket, no question. 

Yes, other surgeons are cheaper, but obviously cost wasn't the only consideration in picking my surgeon.  My philosophy was that I was going to have to live with the outcome of this surgery for the rest of my life, many decades (hopefully), so I need to hire the best surgeon I can.  I was fortunate that one of the best VSG surgeons in the country was only a two-hour drive away.  So I hired him and decided to pay the higher fee because he's a better surgeon, and his patients tend to lose higher than average amounts of weight with their support program as well.