insurance expenses

Ok, I just got blue cross blue sheild (anthem) i have a few questions. Do you think they will approve me? I was told they will approve it if its medically necessary, but do they look to see how long you have been on the insurance? ( i had a long lapse in insurance) another question is. It supposedly covers at least 80% of hospitalization. So will i be billed for the other 20%? Did any of you get big hospital bills after having the insurance approve the surgery? I am wondering because i will be taking time off work, and that will hurt us financially anyway. Tell me your personal thoughts about after the surgery considering insurance...and if you were new member of an insurance company... thanks Kim

Kim, Do you have Anthem BCBS Access? Or another type? I am interested because my Certificate of Coverage under exclusions has a listing that they do not cover services related to weight loss or treatment of obesity? Have you checked your exclusion page. Please let me know what it says. We may be in this battle together. I called them this morning, and they told me that they did not cover it even if my diagnosis was morbid obesity. I am going to fight it if they deny. I am in the process of getting records and pictures together. Please let me here from you. Beth

i am looking at my card, i have anthem bc/bs blue preferred HMO i know someone who had the surgery with the card, i just havent been able to get in touch with her, to ask her some specifics.... it does have that under exclusions, but it says it has to be medically necessary. I have health problems, so i am sure it is medically necessary. ANYWAY.... YOu better fight!! I know if i get denied, i will fight it too... you better beleive it.. this is endangering our lives. It is indeed hindering our normal daily activities. please keep in touch with me... You will get your wls and so will I... talk to you soon Kim

kim Ihave bc/bs i started trying to get approved in dec of2003 and they denied me saying my company changed policy and they would no longer cover it i sent them a app letter and than i got a letter saying that they overturned there dic and would app but i had to do it in 90 dayes my date is sep3th all in all keepfighting sooner or later sombody will listen be like (rockie) when they get you down get back up and fight some moree-mail me and i will tell you my hole story lol p.s my e-mail is [email protected]

Kim, I have Anthem BC/BS HMO (throught my husband's employer in KY) and they approved me within days of having my paperwork submitted. Check your Certificate of Coverage to see if WLS is covered. My certificate states an exclusion for weight loss but specifies that weight loss surgery is covered. I might have to pay for some of the pre-op visits but in the big sceme of things that no big deal! It all comes down to what is in your actual plan. I would suggest calling them first. I called Anthem and found them to be most helpful. There should be a number for member services on the back of the card. Good luck!

I have kinda been keeping up with Your journey, I know You have had it rough and I just want you to keep fighting it WILL happen for You!

ahhhh Shell.. Thank you so much for the kind words.....! YOu made me feel sooo good ...... You will never know how much...Thanks again!!

Right now I am going through all the pre-op tests for surgery. I have an 80/20 policy with deductibles (I think $1000). So far I've paid an office visit fee to the psychologist ($20 but I think I owe $10 more), $400 for my portion of the sleep study (which was charged at almost $4000), and $37.50 for the pulmonary doc to read the sleep study results. I have pre-pay amounts for my surgeon and the hospital that I have to pay two weeks prior to surgery. If I understand insurance (yeah, right!), what we have to pay is 20% of what the insurance company allows. In other words, say some procedure has been done and the doctor charges $1000. If he is participating with your insurance company, he has agreed to accept as payment what they deem "usual and customary" charges. How they come up with that is anyone's guess! OK. Say the insurance company decides that this procedure is only worth $500. They would pay the doctor $400 and you would be responsible for $100. This does not include any deductibles. Clear as mud? Now this was how things were when I worked in doctor's offices but that has been a while ago. Call your customer service line. With this policy, I am estimating $3,000-$5000 coming out of my pocket and that is because I still have to pay for my portion of all the pre-op testing. I am also counting that as setting up my vitamins and supplements for a few months. If you are really serious about having the surgery and think you will have some out-of-pocket expenses, start saving now and looking for ways to put some money back. Maybe take a part time job or have the world's largest yard sale! PS- please, if anyone has other information, feel free to correct me. This is just my .02 that has turned into $1.25.