Hello, I'm new to this site!!

Hello, I'm soooooooo glad that I found this site. I'm learning about RNY and it truley helps to know that there is a forum such as this. I have a couple of questions for the "MARYLANDERS". - Does anyone know of any PCP's in the Rockville, Gaithersburg, Germantown areas that are WLS friendly? My current PCP is a #$%!!! - Has anyone had an insurance that only pays WLS at a percentage? My insurance is a 80/20 plan which sucks because I might have alot of out-of-pocket expense. If you had WLS and had to pay a percentage, approx. how much did you have to pay? Thanks in advance for your help!!

Hi Kendra, Welcome I live closer to Baltimore so I don't know any PCP's in the area you're speaking of. Wish I could help. I have a 90/10 BCBS PPO Plan. I sent a check for $700.00 in to the hospital prior to my surgery because they required it. In the interim reached my max out of pocket for the year (due to all the testing that I had to have done prior to surgery), so I got a refund of $650.00 back from the hospital) The actual surgeon's amount was covered at 100% because I had hit the max out of pocket amount. Does your policy have that in it? I think my max was $1,200.00 for the year (this was for all my medical expenses, not just the WLS related charges). HTH Take Care, Terry

Hi Kendra Welcome to the Maryland group! I don't know anything about PCP's in that area, but I am sure you will get a response from someone with a recommendation. I think my insurance was an 80/20 or 90/10 when I had my surgery, but I also had a maximum out of pocket and then the insurance picked up 100% over that amount so while I might have had to pay 20%, the cap kicked in and I only paid up to $1,500 out of pocket total for the year. Best wishes as your WLS journey continues. Hugs, Mo

Hello Kendra, Sorry to hear that your PCP has issues with WLS. Simple solution -- change PCPs. Call around to several that are in your network and interview them. Ask them if the physician has a position on WLS surgery -- whether or not he/she recommends it for their patients. Your insurance company may also have certified a couple of bariatric clinics within Maryland that are in your area. I have CIGNA PPO and they have ceritifed GBMC and St Agnes -- I believe thus far. One thing to remember when dealing with your insurance company (calling the #800); what your company agreement is may not very well be true for someone else that has the same insurance company. If your insurance is a PPO -- go straight to a WLS Surgeon/Clinic. Most insurances now adays require a 6 month weight loss period and some WLS Clinics will do that for you. If your insurance company has a website, sign up on the sight and conduct a search using the key word bariatric or gastric bypass and see if they have a position paper written on the subject. In that position paper they will have the list of requirements that patienst must meet in order to approve the surgery. The bottom line --know what your insurance requirements are before you get started so you're not caught by surprise. Because I had my surgery after the first of the year, I had to pay 1350 -- 1250 deductible and 100 for inpatient hospital care. I'd imagine that will go towards hospital expenses AFTER my insurance company pays. I hope I get some money back too -- that would be cool. Now any other medical procedures I have this year will be covered 100 percent by my insurance. My niece is named Kendra. I hope the information and suggestions help.

Hi Kendra! Welcome to the Maryland Forum. I want to wish you all the best in your journey. You have gotten great advise already. Best of luck! Cira

Welcome to the MD board Kendra. I had a 80/20 split and my out of pocket was approximately $3000.00. Had 4 days in ICU so that might be why it was higher. Don't know, but it was so worth the money spent. Best of luck finding a PCP. I'm really out of your area, but I'm sure that some Montgomery County on North peeps will speak up. TraciL