Anyone with NCBCBS and Dr. Fernandez?

I am researching RNY surgery with Dr. Fernandez and received their information packet in the mail today.  Do any of you have NCBCBS insurance that covered the surgery at WFUBMC?  The packet had explanations of having to pay the psychiatrist and nutritionist up front, and I am wanting to hear about what happened and in what order with those of you who have had the surgery covered?  Did insurance cover the mental health and nutritionist, also? 

I don't currently have medical problems, but I will if I don't lose all of this unwanted weight.  Thanks for any help and advice.

Hello.  I had my RNY surgery with Dr. Fernandez in July of 2007 and I had a wonderful experience with him and his team.  My insurance at the time was Medcost and my surgery was covered by them.  I did have to pay the nutritionist and psych visit up front as they don't file it to your insurance for you but they will give you receipts and info you need to file a claim to your insurance company for some reimbursement if you so choose.  At the time of my surgery, I paid $500 to the psychiatrist and either $350 or $450 to the nutritionist (I can't remember specifically!!).  I did not file these claims to my insurance company because I was just too lazy to follow thru with it.  I also had to pay my deductible and out of pocket max to the hospital BEFORE my surgery or they wouldn't allow the operation to proceed.  For me, that totaled $3000.  But it was money well spent as I'm only 9 lbs from my goal having lost a total of 137 lbs so far!!!  I feel great, look great, and would do it again in a heartbeat!!  I have had absolutely no problems in the almost 19 months since surgery.

As far as the order of those appointments went, I went to the informational seminar in December 2006, had my initial visit with Dr. Fuzz in February 2007, saw the psych in March I believe and then the nutrionist was in May I think.  It is a long, drawn out process (or was when I was going thru it) but once the ball got rolling, it didn't take long for things to progress.  You just have to go into it with a lot of patience and be willing to play the waiting game.  Now, remember this was just my experience and they may do things differently now, I don't know. 

The only medical problems I had at the time of my surgery was slightly elevated blood pressure and I was a borderline diabetic.  So even though I was relatively healthy at the time I chose to have surgery, severe health issues were knocking at my door.

If you choose to go with Dr. Fuzz and his team, I think you will be well pleased.  He is a fantastic surgeon *****ally knows his stuff.   If you have any other questions, feel free to contact me.  I am willing to help all I can.  Good luck to you!

Hey Donna, I am playing the waiting game now and yes patiences is a must....with my insurance anyway. I have all behind me, nutritionist classes/psychiatrist exam/first visit with Dr. Fuzz . With my insurance BCBSALA  you must have 6 months of supervised weigh ins. I am getting ready to have my 5th this month. I hope to know if my insurance will approve by the end of April - I am having to pay everthing out of pocket. until I see if my insurance will approve. 

You look great - I wish you continued success!  

Thanks for the information.  You look fantastic.  I'm not in a hurry, and my insurance will cover the surgery (I hope).  I will probably attend the seminar this next month to get the ball rolling and then make the appointment with Dr. Fernandez.

I didn't have surgery with Fuzz, but I do go to his support group cause I live in Winston. He is absolutely wonderful and I've recommended several friends to him because they didn't want to drive as far as I did (and I utterly adore Dr. MacDonald). You can't go wrong with Fuzz - he's just great! And yes, NCBCBS does cover the surgery with him.

Thank you for the information.  You both have done fabulous and are inspirations to me.  I plan to attend one of the information sessions this next month.

Hi, AmyLeann,

Fuzz did my RNY last April. And I am very, very happy with the entire process. I also have NCBCBS. I had to pre-pay the for Amber and Jeff (the nutritionist/co-ordinator and the psychologist). The money was very well spent. I have sent in the receipts and from what I last heard, it is still pending. I don't know why. But I will check on it again Monday.  Thanks for the reminder.

Good luck and I hope to see you at one of the upcoming support group meetings.

Dr. Fernandez did my RNY and hiatal hernia surgery October 6, 2008. What a great team!
I have BCBSNC and only had to pay my deductibles and copays. Dr. Smith was "out of network" in June and I paid upfront. BCBSNC only covered a portion. He has since gone "in network".  Amber's fees were paid upfront but I submitted to BCBSNC and they covered a portion of that, too.
BCBSNC has designated WFUBMC a Center of Excellence for bariatric surgery. I was approved the same day as my file was submitted to BCBSNC. I got the call within a couple of hours.
I have to mention Dr. Fuzz's nurse, Elizabeth. She is fantastic! They are all very "approachable" and very professional.

I cannot say enough good things concerning the program that Dr. Fuzz and his staff offer. I know that if I have issues, they are there for me. I feel that they are "my team".

The monthly support group has given me the opportunity to make friends and share experiences with others that know exactly how I feel and what I am experiencing. I learn something new at every meeting. Plus we have fun! Come join us! We always have preops, postops and curious about surgery attending our monthly meetings.
You can also join our online Yahoo group at ~~ http://health.groups.yahoo.com/group/gbsgf/

I recommend this group highly.

Good luck!

Jane J

Hey Jane, Was your hernia a result from your RNY surgery?
I am about 2 months away from having the RNY surgery, if my insurance will cover. I have BCBSAla and this insurance can be a tough insurance company to deal with. They require monthly supervised (for 6 months)  weigh ins with my medial Dr.   This month and then April, I pray I should know something. after April 18th Yes, all I have meet at Dr. Fuzz office are wonderful. I have mostly talked with Amber.  I have had to pay all upfront so far. I have been told that once the insurance approves me that they will reimburse me.
With the distance I live I have only attended one support meeting. I enjoy reading and learning all I can on line.

My hernia was pre existing and my insurance covered everything after my deductibles and copays. I am doing great at 16 months out. I've lost 117 pounds, no complications at all.
Good luck to you!! 
Jane