Price of Surgery in MT

Since I cannot find a search function and have looked several pages back. What did your surgerys cost you folks? Specifically in Great Falls MT. I have BCBS and work for the state, they just added the Surgery back on our plan a year ago. Any one work for  the state out there and recently have this surgery? What was your out of pocket? Bypass and lapband what are the numbers? From start of finish surgen consultation, hosp stay, etc. I know things will very tell me if you had a day or 2 in the host. for a stay. I am seeking in general a ballpark figure. What is this gonna cost me out of pocket. Finger crossed with now complications..

Thanks Wendy

Hey Wendy,
I was one of the first State worker approved for the surgery this year, having my RNY 7/7/08.  I went to Dr. Rohrer in Great Falls.  My out of pocket was about $2,200.  Of course this would likely vary somewhat, and I did have my gallbladder removed (having stones).  Another state worker here (Diane) went to Dr. Martin for RNY and I think she charged more, although I'm not sure what her out of pocket was. 
Hope this helps...

Hi, Sunny  Thanks for the info. And btw looks like your doing great by the ticker on your screen, 1/2 way to goal. Keep going girl.

Yep, helps and keep me on track and looking into things. Another question. When you started the Why Weigh program how long did/do you have to be in that to get approvel for surgery?
Finally found your guys old posts. So sounds like the Why Weigh was pretty much a joke, Ah? But will jump through hoops like the rest of you all.
I called them Mon to get enrolled, now I just have to get a BMI and chlosterol test, from my Dr. to get my happy coach.

     Keep in mind these were the requirements for this year, which was the first year they chose to cover this bariatric benefit.  I don't know if they will continue to be as tough & "by the book" this year.  1) Make SURE you get PRIOR authorization---speak to someone in Health & Benefits.  I spoke with Jackie Dunbar.  This will help later on and in making sure you are following all their requirements precisely!  2) You must have a BMI of 40 or above.  I have a few co-workers who are mid to high 30's and wishin' the requirement was a little lower.  It's the only time in my life I was happy to have had a high BMI!  3) You had to have so many co-morbidities (I think 3-4?) that THEY had listed.  Clinically diagnosed things such as sleep apnea, diabetes, etc.  4) You had to attend the free State Health Screening prior to surgery.  Meaning, I went last October when they offered it because I wanted surgery this year, prior to this October's Health Screen.  5) We had to be on the Traditional insurance plan, and had to be on a State insurance plan for 18 months prior to qualify.  I have worked for the State for 14 years, but I had to switch to the Traditional Plan, as I had been on Blue Choice.  It also looks as though I have to STAY on the Traditional Plan if I want continued coverage for anything related to this surgery.  6) You had to be on the Why Weight program for 6 full months STARTING in January before they would approve.  Even though I joined Why Weight last October, they only counted it starting in January.  7) You have to have documentation (preferably your general physician) of tried and failed wt loss attempts.  Attending nutrition classes, meeting with dietitions and going to support group meetings doesn't hurt.  8) You have a choice of whether you want the Lap Band or Gastric Bypass, but you only have a limetime max of $35,000.  So if you develop complications or future problems that need medical intervention, they won't pay a dime over the max cost during your insured lifetime.  The surgery alone is well over $20,000. 
      The one nice thing about the Why Weight participation is you can submit receipts to get up to $300 back a year for things such as gym memberships, Weigh****chers monthly fees, or even your initial bariatric consult fee (mine was $250 and NOT covered by insurance).  So even though I've met my goal of getting approved and having surgery, I will likely continue to email my Health Coach periodically and stay in the program to get another $300 back next year.  You basically just email how you're doing and feeling, and the Coach is validating or giving you tips on how to improve yourself.  
     Keep us updated!  Would love to hear your progress and what you find out. 

Thanks Sunny,

The BMI over 40 is not a problem, ...Let's see is that good or bad, ah depending. Had Traditional plan for years, that is not a switch . What will be my glitch is the Co-morbidities THEY choose, Unfortunatly I am "healthy" for as fat as I am, BP, chlorestoral normal, I exercise all the time  and do not reap the wt loss benefit, I even teach aerobics believe it or not at 280 lbs. I do have other complication (hypertension of the cereberal spinal fluid being the most damning) not listed in their co-morbidities, have been told by a neurologist and my eye Dr to loose weight, or I will loose my eyesight. This has caused debilitating headaches and I finally found a medication to get the headach undercontrol so I can function. But the Dr's say if I can loose  70-100 lbs it's a 90% chance I will no longer have the problem and need the med's anymore. I have worked my butt of since my finding this out last year.  I have always been overweight and tried to loose this was just a kick in the but, really changed my diet, no more fast food, no fried, fresh veggies, yada, yada, yada...uped my exercise nothing. I feel tons better getting the crap out of my diet, but no weight lost. I am just devistated at this point.

Thanks for listening, Wendy

Hi Wendy~

I'm Diane and I had the RNY in July,  as Amy said I have Dr. Martin for my surgeon, she is great but does seem to be a little more expensive.  So far I have about 3,000 out of pocket and I still have little bills trickling in, like for my gall bladder ultrasound and I haven't gotten a bill from my anesthetist.  And that amount includes about $350 for travel and lodging as I live 200 miles away.

I too, thought co-morbids were a problem, make sure your primary care doc and the specialist for your condition both right letters of medical necessity.  That should work for one, the other if you don't have high blood pressure, check out the GERD.  This is just heartburn or acid reflux.  VERY COMMON and most of us have it, we just live with it.  You need to mention to your primary doc so it gets documented.  I asked mine to put it in as the first code for the billing.  that's all it took for me to get approved.  Good luck with the process, and you can post here or pm me or email me at work. I'm dbrittain@.....

Make sure like Amy advised, you are in Why Weight, 6 mos. doctor supervised diet (it doesn't matter if you lose weight or not), you already mentioned you have the Traditional Plan, you get letters of medical necessity, you attend a Health Screening in those 6 mos. prior to approval, (I got the $99 blood work). And I would recommend talking to Jackie she is the contact for the Bariatric Benefit.

Don't hesitate to ask questions if you have them!

Diane

7) You have to have documentation (preferably your general physician) of tried and failed wt loss attempts. 

What are your experiences with this...Weigh****chers?? What exactly are they looking at here? Would you care to share your experiences?

Thanks girls..

Thinking and praying for you today Carrie!!

I am the Carrie of the group. Follow everything to the letter.1 thing not quite right and they will make you wait. Trust me. My original surgery date was July 14. I will be having surgery on Monday October 13. Those don't let you cut any corners.

Wendy,

The only documentation I had was the last six months of doctor supervised weight loss program that I was on at the time.  I didn't lose much, I think I lost about 9 pounds the first three months and ended up putting weight back on by the end of the six, so much so that they couldn't measure it because the scale only went up to 350! 
There is a diet history to fill out with either Dr. Rohrer's or Dr. Martin's application.  And yes, Weigh****chers counts.  I also put down the cabbage soup diet, the hard-boiled egg diet, dexatrim, liquid protein diet, the chicken diet, the Richard Simmons Meal-A-Deal Diet, the Susan Powter diet, etc. anything you have tried to lose weight with.
I'm not sure if this is what Amy is referencing here. 
Why Weight is very easy.  You just send an email to your Health Coach once every three months to check in.  Say something like I am working on eating smaller portions and exercising three times a week.  They'll email you back with words of encouragement and support. Maybe give you some links to info about exercise and portion control.  That's all they can do really, they are not licensed to give medical advice.

I had been in Why Weight since it first started.  I do like the $300 reimbursement benefit.  You'll get the info on what is and what is not covered by that when you sign up.  It's an easy hoop to jump through.  I would check out though if they will let you go from October 2008 to April 2009.  We had to start our six months in January of this year, anything previous didn't count.  Call Jackie Dunbar in HR to ask that question.  She'll also give you all the other conditions and co-morbids needed. 
As I said before, I too was considered healthy except for my weight, but associated conditions were developing as I aged.  I had a sleep study done in 2005 when I first applied for this and it was found I had borderline sleep apnea.  I had lower extremity edema (swelling) that had developed in the last couple of years.  I also couldn't walk very far because of the knee pain that was getting worse all the time and I couldn't stand for more than 10 to 15 minutes because of the back pain. Sleep apnea is one of the co-morbids.  But as I said mine was borderline. Along with the other conditions that I had (not really co-morbids) that were documented we threw in the GERD as it is very common and likely that we all have it to some degree or another. It's something you could just live with thinking it's just something you have to live with because you're overweight. So for whatever reason, my co-morbids and documented problems or the fact that I had been emailing HCBD and our union for three years about getting this covered. I got approved.

I will say though that I have already reached the $35,000 lifetime maximum for this benefit, so I think that is too low.   I do plan on switching to Blue Choice again during open enrollment because as I understand it I will not be eligible for any coverage anyway if I did develop complications at a later date.  I do not believe I will anyway.

So as I understand it, you need to have six months with a PCP, make sure the appts are coded for weight-loss-obesity.  You can get reimbursed for your payment of these appts. through Why Weight.  Make sure you document every little thing you are having problems with due to your obesity.
You need to have six months of Why Weight- again, check with HR to see if it has to be in the same calendar year.
You need to have a Health Screening done within the last six months I believe. 
You need to have a bmi over 40
You need to have two co-morbidities
You need to meet with a nutritionist-which you'll do through the Bariatric Center at Benefis
You need to have a psych eval which you'll do the same day as the nut at the Center. It's a breeze, believe me, he asks you what kind of support you have at home, how long you've been overweight, do you understand the risks. In all it's about 10 questions and you see him for about two minutes, if that.
After seeing my surgeon, she sent me to get an EKG, blood test for H. Pylori, a bacteria in your stomach that could indicate you'll have ulcers post surgery, a chest x-ray and a gall bladder ultrasound. I did all of these except the ultrasound the same day at Benefis. You walk right in and they pretty much took care of me right away. they also take care of sending the results to the doctor. The ultrasound I had done at a hospital near me as you need an appointment for this.
Oh, and I had to get certain blood tests redone when it was time for surgery. They needed it within the 30 days prior to surgery and my Health Screening tests were three months prior.

And I ask that when you do call and talk to anyone in HR or HCBD or Blue Cross that you do not reference me or anyone else specifically.  You just never know. Don't mean to sound paranoid but like I said you just never know.  If you do go to Dr. Martin, please feel free to give her my name as a person you have had contact with.

This may sound like a lot but it's worth it!  I'm very glad I was finally able to get this tool. It is great to see the pounds come off and not be hungry!

Diane

Diane,

Thanks for the input. Ya it is alot, but better to hear it from those of you that have jumped threw the hoops. NIce to her from those who have the experience. No, I would never referance you in my quest. been in business to long to know that. My parents both owned businesses and I just would never do somethign like that, makes for a sticky situation. I may be blond but, Im not as dumb as I look.... He, he. But on the flip side know if you had good reviews of the Dr. would probably be OK in that arena, but thanks for the permission. I work with 2 that have had surgery from Rohrer that was 3 & 5 years ago, and they used their husbands insurance. They loved him and tell me to go to him if I do anything.

I had my gallbladder taken out, 4-5 years ago now so that's one less for me to worry about. But yes I actually do have GERD, and just fight it on and off, depends on what and how I am eating, yada, yada, yada. I just forget about it. And do have alot of weight related depression, my knees are not as bad as yours but sure grid as I walk, back pain, feet always hurt spent tons on the poditrist.,

I would love to see in my life time not hungry. Great for you. Happy for you. Good luck and enjoy.

Thanks for the time the the info,

Wendy