Insurance info please?????

Hi my name is Jen and I want to get the VSG w/ Dr. Cirangle as my surgeon. What I want to know is, has  anyone had this surgery w/ him, who had insurance with HMSA-HMO. If so, any info you could give me would be welcome such as was it approved? how much was covered and an estimate of your out of pocket expense. I went to see my doctor on wednesday and finally agreed to get surgery done. I go back to see him in a month. What I want to know is should I wait till my next visit, or should I schedule a consult on my own, and just let my doc office know the scoops? This is all so confusing. Also, is the consultation free, or do I pay a co-pay? Sorry, so many questions.........thanks up front for all who answer any of these questions.... 

Well congrats on making an important move to correct your health. As for me my first choice was to go to Dr. Cirangle. I hear nothing but good things about him. I made my appointment and was very excited to go to my appointment. I had to go see my PCP to get a referral. Well when I went to the PCP he said that he wouldn't refer me to a surgeon that don't do his surgeries here. So he sent me to see Dr. Fowler in Kailua. Let me tell you something he is really nice and so is his staff. I really like the idea of having my surgery her in Hawaii. I really didn't want to fly to San Fransico to get my surgery. My first choice was the VSG. But HMSA no longer approves VSG unless your BMI is over 50. That is another thing. Contact your insurance company to see what your policy covers. Another thing is that Dr. Cirangle's surgeon fee is $4500 and Dr. Fowlers is $600. With both proceedures the surgeon fee covers follow ups, dietian, and monthly follow up meetings. You still have to pay your co-pay. For my policy with HMSA I will have a final bill of $1200.00 for Dr. Cirangle you will not have to pay the hospital stay that is covered by him. You will just have the pay for the surgery % that is not covered by your policy. Very important to call your insurance company.

I agree with Nahea. I am a patient of Dr. Cirangle, but I had to self-pay because my insurance company would not cover a procedure done outside HI. I didn't like the insurance company dictating which procedure I would have, so I was fortunate to be able to self-pay with the help of family.

However, my insurance DID pay for ALL the pre-op testing, medications, and consultations (and offered to pay for a second consultation with another doctor on Oahu if I were to change doctors) but I really wanted Dr. C.

Talk with your insurance company and find out what your out-of-pocket expenses will be. They should tell you up front.

Malama pono.

thanks, the info helps a lot. my BMI is over 60 so i hope that means i can get the VSG. i REALLY wanted dr. c. i think that's who my pcp has sent his patients to for surgery, cause the nurse said they have sent a few to san fran, but they also work w/ docs from oahu. and WOW $4500 and $600 is a HUGE difference. I don't have anyone that can help me pay, and making any kind of loan is unfortunately not an option, so cost is a big issue. so i think i will look into some hawaii docs. i would like to have my surgery in hawaii so my husband could be there with me. if i go to san fran, i would most likely be going alone.  but anyway, thanx for the info

HIGURL is from maui and she is going to Dr. Fowler also because she is having hard time paying the $4500 for Dr. C. I think HMSA is paying her back to fly back and forth. She will probably comment back by monday.

FYI - I hope you get to stay in HI and your insurance pays. With the packages from Dr. C, my hubby got to stay with me (we had to pay only for his airfare because I was a self-pay, but he was able to stay the week with me... one night at the hospital and the other days in the hotel nearby) without any additional cost. I wish the hospitals here in HI met Dr. C's standards... hopefully, they will someday soon. I'm just glad I get to have my follow-up visits with him here on Maui and knowing that he is just a phone call or email away. He's really good at getting back to me if I need him.

Let's see if HIgurl has anything to contribute, though. She may be an excellent source of information! Aloha!

Hi Jenn,
Its me HIgurl....i had the same situation as you...i was going to go with Dr.C and i did go for a consult with him...i didnt need a PCP referral to see him.  He is really knowledgable and has a lot of experience but his $4500 is just too much for me to come up with.  So thats how i got hooked up wtih Dr. Fowler.  I just went to Oahu in fact for a consult wtth him.  I know that DR. F will do VSG on ppl who have a BMI of 55 and above.  But he says he doesnt think HMSA will cover it.  If they deny it, you can always appeal.  But if you are thinking of doing the VSG, I would recommend going with DR. C as he is much more experienced with that type of surgery.  Dr. Fowler mostly does lapbands and RNY (which i am getting).  Like Nahea said, I think you should call HMSA first and find out what they cover.  I will say that i like both of these doctors.  But i f i was rich and had money, I def would go with DR. C just because he has many years of experience.  Dont get me wrong, Dr. Folwer is competent too and i am going with him for mus surgery...but whatever u choose, research and research!!!  Good luck and let us know how it all goes!

thanks for the info HIGurl. i called HMSA this morning, but the lady needed the surgery code for vsg, my docs office didnt have that info so i called dr. c's kona office and got in touch with nicole over there. she said i had to call the san fran office to set up the consult cause get special instructions or something for people that had HMO. and they were closed..........  so frustrating. lol. i'm not a patient person. i have spent the last week and a half reading so much people's stories, looking at their pictures and literally seeing a huge difference this has made in their lives, laughing, crying, it just hits you right there, you know? i want what you all have, or will have soon. and now that i have finally made the decision, i am terrified that i won't be able to get it. i try to think positive, but i don't want to get my hopes up for nothing. in all honesty, i really don't think i've ever wanted anything so much in my life. sorry, had to vent. anyway, aloha to you all. thanks again.

Hi there...just wanted to chime in and say a few things. First off, congratulations on your quest to a better feeling you! Secondly, whatever doc you choose and whichever route you decide, it'll all work out. And time really does fly. Soon you'll be on the losers bench.

aloha,

michelle