Insurance

Has anyone out there have BCBS Federal Oklahoma?  Anyone had surgery with this insurance?  Just curious what your out of pocket exspense was for lap band.  I talked to Integris today and they said it would be $1500.00 out of pocket not including the anesthesia.  Any help on this would be great.  I sure hope this isn't true because I may have to opt out if its several thousand .  Help!!

Sorry that I can't answer your question.  I was self-pay.  But welcome to the Oklahoma board and I hope somebody comes along to answer your question.  Hang in there!  It is so worth it!

Kim

I have Fed BC/BS and they covered outstandingly well. There will be some small amounts you have to pay as co-pays, but nothing huge. Just check the insurance coverage online brochure at www.fepblue.org and you will see what you have as your co-pays.

The biggest factor in how much you will have to pay *out of pocket* is choosing a surgeon that is listed in the Preferred Providers directory. If you choose a surgeon that is *out of network*, you will end up paying a substantially HIGHER amount out of pocket. You can check in the online physician directory to see which bariatric surgeons are listed as *Preferred Providers*. If they aren't listed online, they haven't signed an agreement contract with BC/BS to accept their payment for surgery and they can charge much higher and you will be responsible for a much larger portion of the fees. You can also call Fed BC/BS at 1-800-722-3130 and ask specific questions. Also, Fed BC/BS does NOT do predeterminations. If you qualify by NIH criteria for bariatric surgery, you qualify and they cover. No hassle! Qualifications are BMI of 40 or greater, or BMI of 35 or greater with 2 qualifying comorbidities (diabetes, dyslipidemia, hypertension, and a few others). They do not accept all comorbidities. Call to get a complete list of qualifying comorbidities.

Good Luck!

I forgot to add that your protein supplements or other dietary supplements will not be covered. You may need to cover the psych evaluation or dietician consult...it just depends on the program/surgeon you go to.

BC/BS covered my VSG and I couldn't be more pleased.

Thanks Shelly.  I think the difference may be with the lap band being an out patient.  23 hours stay is considered out patient and it goes to 15%.  Thats the best answer yet.  I was just hopeful someone out there had the lapband with our insurance.  I just hate suprises with insurance.  As far as the Anesthesian, they say they won't even know that until right before the surgery.  It just gets so darn complicated sometimes.

I will tell y ou if you have sleep apnea he will likely have you stay overnight , you should ask about that , i think i went home about 10 am the next day

I believe my surgeon always works with the same anesthesiologist and he is also a Preferred Provider. My portion owed to the anesthesiologist was a bit over $90. My portion owed to my surgeon was a bit over $100. 

My portion owed to the hospital was very little ... about $100. 

My biggest advice is to make sure your surgeon, anesthesiologist and hospital or outpatient facility is a preferred provider with Fed BC/BS. Your expenses should be very minimal in those situations.

just remember YOU are worth it!!!

I have BCBS Federal Basic plan and when I called them before surgery, I was told that my surgery would be covered and I would have a $100 copay for surgeon and $100 per day hospital fee.  However what they did not tell me was that they only pay a percentage of prescription drugs and medical supplies/devices.  I had to have an EGD before surgery and that ended up costing $40 copay then afterwards (by the time I had already had surgery) I was billed for the meds and supplies used for my EGD, about $150.  Also I had to have an inferior vena cava filter to prevent pulmonary embolism due to my BMI being over 50.  My surgeon requires this for safety sake so I did it.  This was a $10,000 procedure and my portion afterwards was $989 so roughly 10 percent.  That medical device was a little pricey $4,000 all by itself. and that is where most of the $989 came from.  I had my surgery 3/31/08 and have not been billed yet for the actual surgery.  So I don't know how much my total out of pocket is yet.  But I am not sorry, not for one second.  We are a one income family of 5 and things are tight but I keep making payments to all the doctors and Bailey medical center what I can, and if thats not enough then thats too bad for them.  Hope this helps.  Dionne