HELP WITH FED BCBS

I went to Weight Wise in Edmond Ok. the Dr. said that Fed BCBS is easy to get approval but, that i would have to pay up front 3,000 or more. Does that sound about right for BCBS Fed.? The DR. Said that he is not in network!! I have stanard BcBS Fed. My sleep study is for Tuesday the 16, 2007 and to pay at less 3,000 if anyone has a better plan please write me back!! Help Ronda

Dr. Keith in Norman is in network. I'm not sure what my out of pocket will be yet. I can tell you what I've paid so far. Hospital 100.00 per admittion. 15.00 co pay for the doctor's office visits. 15.00 for the phsycologist (sp?) appointment, 15.00 for the physical therapist. I also had to pay 200 for the dietitan, but we are trying to get bcbs to cover it since I've had the surgery now, that will be out of network though. Since it's a new year we will have to pay the deductable, not sure if that will be toward all the pretesting lab work or the doctor. BCBS Fed does not pay for an assistant, and Dr. Keith will not do the surgery without one. That will be another 500.00. I don't know what his total with be but we will pay 10%. I've heard est the surgery all together will be around 15,000 without ins. I'm not sure if that's true or not, I have not been told that from Dr. Keith. He's a good doctor so far. LOL It's hard for me to say since I just had surgery on the 11th. You do have tons of lab work done, and have to follow a special diet before and after surgery. You can go to doctor Keith's website, it's OWLO.com With an out of network doctor you will have to pay more. You will also want to make sure the hospital is in network. I believe (I could be wrong, I'm on pain meds. LOL) the your cost would be 20% for an out of network doctor. Also remember to look your doctor up on the medical board website in Oklahoma. Hubby had a sleep study done also, seems like it was out of network and was expensive, so you will want to check on that also. Good luck and let me know if there is anything else I can help with. Melissa

Hello, I have messaged you before, i believe it was right before your surgery. I had a concultation with another doctor Thursday. I was told that i woud have to see a nutrutionist for 6 months before surgery. I saw your message and called Dr. Keith's office and told, not true. I am going to make apointment with Dr. Keith as soon as the roads clear. Thanks. I do have BCBS Federal. sun1234

You have to attend a siminar first. They are usually every thursday. You will have to fill out a patient packet, but you can download it online (owlo.com). I attended my siminar on Nov. 30, 2006. They got approval the next monday or tuesday. My appointment with him was on Dec. 15th. If I were a week faster then I would have been able to have my surgery done by the end of the year. As it was I had to wait until the holidays were over. As you know I just had my surgery on the 11th. I have BCBS Fed. standard option, but it's the same benifit for basic. HTH!!!!!!!

The $$ that you are talking about sounds like the out of pocket expense for Fed BCBS. Your Member Management Specialist or the Patient Advocate at WeightWise should be able to walk you through the individual costs. Dr. Walton and Broussard and FBH of OK are not in network, but because WeightWise is funded differently, don't count them out until you can review all the costs involved. Also, if you have standard BCBS, you may want to check to see if WLS is covered. I know there is one type of BCBS Fed that doesn't cover any WLS. I am a member of WeightWise and a patient of Dr. Walton, he is a great surgeon (as is Dr Keith) but I am partial since he performed my surgery in 7/06. Foundation Bariatric Hospital of OK and WeightWise have the ability to determine their specific charges based upon your insurance - even if they are not in network. Check it out before you run. It will be worth at least getting all the information. Good Luck. Ruth

How is WeightWise different?? I really didn't look into them because they weren't on BCBS Fed. Which BCBS Fed ins doesn't cover any wls?? I know it's covered for standard and basic option. The difference could be good enough to pay the extra money, I really don't know. It's something to think about. Make sure to do tons of research. I took a paper with TONS of questions. LOL Hugs, Melissa

I had my RNY on Oct. 30, 2006, and I also have BCBS Federal Standard. I paid an initial consult fee with my surgeon of $425, and that will be credited toward any balance I owe once all the insurance goes through. I had to pay $300 for a consult with a psychologist, and I see that it is now a covered benefit in 2007. I've had tons of small bills for my share of costs for all of the exams I had, plus the $15 co-pay. I've probably paid about $1800 out of pocket so far, and I'm waiting for the insurance to pay (which they are in the process of doing), and so now I'm just waiting to find out how much more I owe. For coverage that is supposed to be so great, I'm finding that I'm being nickle and dimed to death for this little bill and that little bill. I have been keeping all the bills from this adventure, so I'll be really interested to see where it all ends up! Good luck to you!

That's weird becaused they pay for psychologist appointment. Mine was a 15.00 copay, my appointment was in 2006 so the 2006 benifits applied. Did you file it with BCBS? I had to pay for the dietitan, but I've filed a claim for part of it back (the dr's office doesn't file ins for dietitans). I don't know what to say about your surgeon requiring a $425 initial fee. I know I'll have to pay a $500.00 assistant surgeon since BCBS doesn't pay for it. Hugs, Melissa

On page 48 of the BCBS Service Benefit Plan booklet, it says it covers assistant surgeons/surgical assistance if required because of the complexity of the surgical procedure. I think my surgeon always does the surgery with another surgeon as a team. I sure hope the assistant is covered since I will probably have my surgery next month.

My daughter had her bypass June 2004 with Fed BCBS. We had no problems getting approval and they paid almost everything. We paid the $15 office visits, $100 hospital and the 10% doctors bill. She didn't have a sleep study so I don't know how they would handle that. My daughter did have complications and spent a week in ICU. Her final bill was a little over $90,000. We only paid out of pocket around $800.00 BCBS paid all the rest.