Approval but what the....

Blessedfruit
on 11/16/09 2:00 pm - Los Angeles, CA
Hello Everyone,
I made the decision to get WLS... Found a surgeon after meeting a few, jumped through the hoops, saw a shrink, hell I even drunk the chalky stuff!

After all of this my PPO ( Anthem/ BS BC) approved me  !!!

After getting the notification from my doctor"s office I was told that my insurance does not cover a surgical assistant, therefore I need to bring in 1767 in a money order or cashier check to my pre-op appointment!

Is this regular practice? I fell like I was mislead- Please Advise

BlessedFruit        
Wendy's Dream
Came true

on 11/16/09 11:49 pm, edited 11/16/09 11:49 pm - Mesa, AZ
VSG on 08/09/22
I don't know much about anthem / BS BC.  When I started the WLS journey I started with 1 surgeon that had an assistant surgeon that was out of network and they want me to pay $5000.00.  I changed surgeons 2 months before I got approved.  The new surgeon didn't us an assistant. My insurance paid for the whole surgery all I had to pay is my $100.00 co pay.  I think there are WLS places that want to make extra money.  Not sure if the one you are using does or not. 
Good Luck
 Wendy  

   1st fill 4cc,  2nd fill 1.5cc  3rd fill 1.5cc 4th fill .5   Total 7.5 cc  in my 11cc Realize Band.
                     
 Reached 1st goal weight 158 on 6/8/10, My Starting weight 235  
                                               Hit final goal of 145  10/25/10 
                                                    
  Current weight 143  
                                If you work the band the band will work for you.
    
              
Blessedfruit
on 11/17/09 12:52 pm - Los Angeles, CA
Thank you so much for the information. Strange enough after I told them it would present an ecconomic hardship I was called and told the cost was $1,100.... I did schedule for next year tenative. I was wondering if another surgeon would be an option for me. everyone I know has paid noting other than a standard co-pay.

Thank you for the advise, I am going to exercise that option.
BlessedFruit        
Wendy's Dream
Came true

on 11/17/09 11:46 pm - Mesa, AZ
VSG on 08/09/22
I think some Surgeon try to see what the can get away with and they will settle for less.
I was wondering what was billed to my insurance. So far this is what the insurance has paid.  They paid the Surgeon  $1302.25 he billed them for $1952.00.  
The Anesthesiologist was paid $1080.00 he bill was for $1840.00.  The hospital has not been paid yet, but billed the insurance  $39,695.00.  We will see how much they get paid.   I decided to go with a not for profit hospital and for what I was told that they only get paid what the insurance agrees to pay.  I did have a co pay for the hospital and that is $100.00 per day.  I was lucky to get to go home the same day.
Good Luck
 Wendy  

   1st fill 4cc,  2nd fill 1.5cc  3rd fill 1.5cc 4th fill .5   Total 7.5 cc  in my 11cc Realize Band.
                     
 Reached 1st goal weight 158 on 6/8/10, My Starting weight 235  
                                               Hit final goal of 145  10/25/10 
                                                    
  Current weight 143  
                                If you work the band the band will work for you.
    
              
GigiNorth
on 11/18/09 1:39 am
I would ask them more information.  Who is the assistant, and what professional designation/license does he have?

In my case the surgeon uses a CRFA as the assistant and my policy doesn't cover that type of provider. 
Gigi North
ohio1955
on 11/24/09 2:09 am
I had to pay for an assistant and have no regrets. I was told up front and thats how it was no exceptions. Mine was 500 plus a 35 copay. I live in Ohio too so its most likley way cheeper here.
I paid extra for a program and the assistant which was also not negotible. I must say its been good though. My wife went through a surgery years ago and had none of the support.  Ihad to pay at my pre-op too.
            
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