BCBS PA - Highmark PPO Blue

Band_Groupie
on 1/9/09 1:52 am
Just an update.  I didn't have much luck with the insurance co. this week other than to confirm that the policy that I have a copy of didn't change since last year.  I also confirmed that my deductable (initial $250) hasn't changed and the same with my percentage (10% up to a total of $1000 max for the year, then they pay 100% up to 2 mil.).  I couldn't get any clarification on some of the details...I'd ask if this was the same for anesthesia, etc. and she'd just rattle off the same things I stated above.  I tried getting clarification on "what constitues 6 mo." and even after going back to her supervisor she came back with outpatient vs. inpatient procedures for gaining approval and which dept. covers each...I tried to clarify that yes, I'll be inpatient, but what I asked was how long is 6 mo.?   She transfered me to the pre-authorization dept. and the girl there acted p.o.'d from the get-go that I wasn't from a Dr.'s office...came to figure out that all she could tell me was that my surgeon's office would be faxing the info. to them for approval (why she couldn't answer the 6 mo. question either, I don't know 'we don't answer benefit questions').  I wont bother telling you what happened with my 'fill' question other than to say 'what's that?' was part of the non-answer.

Long story short, I'm meeting with the insurance expert from my surgeon's office next Tues. as part of my surgeon consult meeting.  I'll take all my questions to her an find out what I still need to confirm with my insurance (and give her a copy of my policy).  I'm guessing she'll know exactly what the answers are as she's really familiar with Highmark PPO Blue.  I'm not going to sweat this as I want to talk to several people at the insurance co. anyway so I can document answers (took names/date/time), so next time, if I get nowhere I'll escalate it to the supervisor.  For now I'm just playing everything safe and I won't let my weight get below the minimum 35 BMI (10 pounds) before approval, which was another question unanswered.

VALERIE- Thanks again for your help!  I'll keep you all posted on how the insurance goes in case someone is in the same boat.

Band_Groupie  My Blog "The Sweet Spot" HERE
Proud member of the Century Club...100+ pounds gone forever! 
I'm now in the middle of a Normal BMI.
*My new adventure; At the suggestion and support of many LBers, I'm now writing a LB book.

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