insurance BCBS???anyone???

bellacherie
on 1/3/12 8:24 am - Alanson, MI

anyone can help me out please with the getting approved process, i am a 35 BMI, or will be, and i have sleep apena as well i have a stoma that is stretched outta shape because i got pregnant 8 months out of my RnY, thanks

gak
on 1/3/12 11:17 am

Revision on 06/21/13

Which BCBS, as in what state? and Any other medical issues ? You need to get a copy of the requirements for your plan from the plan administrator and learn what the requirements are for your plan.

Ginger<><
Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire 5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm

bellacherie
on 1/3/12 6:17 pm - Alanson, MI

state of mich, and a plan is PPO, if that means anything, i have a finance guyy looking into it from the office of dr rapkin in cali, so excited, i should know by the end of the week

gak
on 1/4/12 11:46 am

Revision on 06/21/13

great replies down in the thread. Dr Rabkin's office knows what they are doing with insurance and so dothe insurance guru's as mentioned below... they are wonderful !

Ginger<><
Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire 5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm

bellacherie
on 1/3/12 6:18 pm - Alanson, MI

also whats the DS cruise about , lol

gak
on 1/4/12 11:47 am

Revision on 06/21/13

Follow the link for more info on the Cruise. We did the first one last yr and had such a good time, we are planning a second one for this July. We are taking over the Lido deck on the ship ! LOL Other decks available as well.

Ginger<><
Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire 5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm

fullhousemom
on 1/3/12 8:23 pm

DS on 10/11/11

PPO = preferred provider organization. It means you must choose from a certain group of providers. Your coverage is going to depend on the contract language of your plan.

fullhousemom
on 1/3/12 8:33 pm

DS on 10/11/11

With only one comorbid, sleep apnea, and a bmi of "almost" 35, dont be disappointed if its not covered. Usually you need two comorbids at 35 - 40. A stretched stoma is not a comorbid. It wont kill you; unfortunately, it will just cause you to gain weight. And once you are at 40, your surgery should be covered. Vicious circle.

It appears that your surgery is to be a revision. I dont have any idea what the bcbs guidelines are for a revision. I do know that with a PPO, its unlikely that it would be fully covered if you go out of state. I think, if it does turn out to be covered, it will cost you more out of pocket to go to an out of network dr.

Good luck!

Jody W.
on 1/4/12 2:35 am - Windsor, CT

DS on 08/16/11

I think that it depends. I have BCBS of CT and I went out of state for my DS. I had to go to NY and Dr. Roslin was considered 'in-network' under my plan. I will state that my plan is very generous with the coverages that it provides.

Original LapBand Surgery - 07/26/06- DS Surgery - 08/16/2011
HW/LW/SW/CW/GW
289/195/277.5/242.5/170

southernlady5464
on 1/4/12 4:44 am, edited 1/4/12 4:44 am

DS on 01/24/11

BCBS depends entirely on 2 things...who "owns" the policy as in who you are going thru to have the policy and 2) which state it is located in. Each state is considered a separate company.

Now, PPO means Preferred Provider Organization: While you can choose who you go to, in network is much cheaper for you than out of network.

A preferred provider organization (PPO) is a managed care organization of health providers who contract with an insurer or third-party administrator (TPA) to provide health insurance coverage to policy holders represented by the insurer or TPA. Policy holders receive substantial discounts from health care providers who are partnered with the PPO. If policy holders use a physician outside the PPO plan, they typically pay more for the medical care.

Found this: ereferrals.bcbsm.com/bariatric_surgery.shtml

It might help, it might not but the critical question is your actual BMI and your co-morbids.

Good luck.

Liz

insurance BCBS???anyone???

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insurance BCBS???anyone???