SHBP - Insurance Post Op
Okay...I know I am thinking ahead, but, here is my question. If I go back to a regular HMO to save money next year during open enrollment, will it cover my visits to my surgeon for checkups? What if (God Forbid) I have some sort of emergency related to the WLS - anyone know how that would work? I know I can call to ask - I just though someone might have already done so.
It should. Surgeon is on the plan, so it would cover with an office co-pay. Last year, when they didn't have the coverage for surgery at all, I was on UHC HMO and had 2 different surgeon consults. Both were covered by a copay.
On the flip side, I might stay with this plan. It's working out well for me. But next year, I would have them take out $500 for the savings plan so there isn't a gap between the $500 they give you and the $1000 when things get covered at 10%. Since surgery is all over and the maximum out of pocket is met, everything for the rest of the year is FREE!!!! Medications...lab work...tests...doctor visits... It's great to go to Walgreens and not have to pay!
On the flip side, I might stay with this plan. It's working out well for me. But next year, I would have them take out $500 for the savings plan so there isn't a gap between the $500 they give you and the $1000 when things get covered at 10%. Since surgery is all over and the maximum out of pocket is met, everything for the rest of the year is FREE!!!! Medications...lab work...tests...doctor visits... It's great to go to Walgreens and not have to pay!
Highest Weight/Surgery Weight/Current Weight/Goal
426.4/356/216.8/165?
I think it works out better for a single person than a family. My max out of pocket is like $4000. My DH and DS are both healthy as horses - so it is just me. We also don't have a flex account (don't know why county won't do it - doesn't cost them anything!), and with me not working full time next year, $500 is a lot anyway. I just had to write an unexpected $233 check for the 10% copay for the nucluear stress test! ARG! That hurt!
You SHOULD NOT have had to pay the 10% copay for the stress test at the time of the visit!!!!! In April, I received something from SHBP, a wallet card (when you fold it in half) that you can give to the docs office that implicitly states they are to take no money from you, bill SHBP and then bill you for any remainder.
Highest Weight/Surgery Weight/Current Weight/Goal
426.4/356/216.8/165?
None of my docs this year have required money upfront (even when I knew I would owe). The cardiologist (I was referred to the same one at you) was the only one who wanted money up front. I gave them that card and it took them 15 friggin' minutes to confer with the office manager before they agreed to bill me.
Highest Weight/Surgery Weight/Current Weight/Goal
426.4/356/216.8/165?
Mine have billed me for everthing too. You can get the card from the shbp microsite.
I have been making payments on the larger bills and paid the small ones off. The surgeon requires his co-pay ip front though. I haven't found away arount that. Since I'm only $700 from my $2000 max, it shouldn't be too much if a burden. I have been saving for it.
I have been making payments on the larger bills and paid the small ones off. The surgeon requires his co-pay ip front though. I haven't found away arount that. Since I'm only $700 from my $2000 max, it shouldn't be too much if a burden. I have been saving for it.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I 
MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
Oh back to the question .... duh... can u tell I've had a busy Saturday...
I am sticking w/ the HRA. In case you need a revision or something. I think you'd need it. I guess you need to pull the HMO benefits and check the exclusions to see what they will and will not cover. I'm single, so the $200 max works for me.
I have the flex account $100 per month or $1200 per year, and that was helpful for the copays. I never missed it in my take home pay. I plan to get braces next year (the next step of my self inflicted Extreeme Makeover) , so I think I'll keep it.
Let us know what you decide and why. I assume we'll have to choose by November.
I am sticking w/ the HRA. In case you need a revision or something. I think you'd need it. I guess you need to pull the HMO benefits and check the exclusions to see what they will and will not cover. I'm single, so the $200 max works for me.
I have the flex account $100 per month or $1200 per year, and that was helpful for the copays. I never missed it in my take home pay. I plan to get braces next year (the next step of my self inflicted Extreeme Makeover) , so I think I'll keep it.
Let us know what you decide and why. I assume we'll have to choose by November.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
I am not sure if this is an option for you, but in my husbands county they have American Fidelity and AFLAC who come around and sell Medical Reimbursement and Childcare reimbursement plans. The money that is paid in each month is pre tax dollars so it saves you in the long run. As well as it takes care of all our needs during the year and we never miss it from our check.
Melodie
Melodie
Most Active
Recent Topics
