Anyone on the State of Maine Anthem?

Is there anyone here who is planning surgery who is covered through State of Maine employment health insurance?

Warning- there are changes in the health plan starting July 1, 2009. ONLY bariatric surgery at a Bariatric Centers for Excellence will be fully covered. If you are going to EMMC or MMC they are BCOE. If you are going elsewhere you will not be within the preferred network.

Plan accordingly- if you can move your surgery date to before July 1 you will be fully covered.

I work for State of Maine, Health and Benefits. PM me with questions if you don't want to broadcast in public.

I don't have that coverage, but thank you for giving a heads up to those who do!

Hi!

I am on Anthem through the State of Maine.  I am having a WLS procedure this summer which has already been preapproved by Anthem.  I had to have emergency surgery 3 weeks ago to remove a failed Lap Band so my doctor wants to wait to a couple months before putting my body through surgery.  I go to Maine General in Augusta and I BELIEVE they are a Center of Excellence... should I push to have surgery prior to July 1 or should I be all set since it has been pre approved?

Thank you for your help and advice!!!

Donna

There are only 2 Bariatric Centers of Excellence in Maine. The programs at Eastern Maine Medical Center in Bangor and Maine Medical Center in Portland. Bariatric Centers of Excellence encompass ALL of the services leading up to and after surgery whi*****ludes the program, nut, counseling and psyche test, surgeon and hospital.

Pre-approval just means that Anthem will pay their contracted amounts for this surgery

By having bariaric surgery AFTER July 1 you will be subject to the new contract rules which will treat Maine General as a non-preferred hospital and the surgeon's fees as self referred.

Financially what does this mean?
Hospital- you will have met the $200 deductible already with your lap band removal. You will have a $100 per day co-pay up to $300. maximum. This will be true before and after July 1 as Maine General in Augusta is not a preferred hospital on our plan.

Surgeon- you will owe the $200 self referred deductible, Anthem wil pay 75%. You wil owe 25%. The 2 or 6 week follow-up visit with the surgeon is considered part of the surgery package and is no charge.
Subsequent visits - your 6 month, 12 month visits will be subject to the75%/25% and the annual self referred deductible.

This is "off the top of my head" I will check the contract at work tomorrow. 
Bottom line- if you can get the RNY done before July 1 you will save $ on the surgeon's fees.