Question:
I am so sad! I was just informed that the BTC does NOT accept my BC/BS of Mi.
I am willing to change insurances but I am unable to do so until June. I want to know if I do change insurance will the "New" insurance have a waiting period or concider this a pre existing problem. I know the insurance I have now does cover this surgery just NOT with the surgeon that I want to have, or at the locations I want to be at. Please help I am so let down today! — Sassy M. (posted on February 13, 2002)
February 13, 2002
Do you have Blue Care Network? Or the PPO? Maybe you could switch over to
an individual policy....it would cost you more money, but if you go onto a
PPO maybe they would cover it. Check it out. I don't have any insurance if
I don't hurry up in the next week and sign up for group conversion. Maybe I
can find the PPO main number for you. They might not have a pre-existing
condition clause if your were on Blue Cross for a certain amount of time.
Michelle
— Michelle H.
February 13, 2002
Michelle thanks for responding. I dont really know what I have. I think its
an hmo. Its blue cross blue shield blue choice of mi. It is 104$ a week. I
have to see the Dr's THEY have in network. Its a crock if U ask me!
— Sassy M.
February 13, 2002
Hi Connie, I am sorry about this bump in your journey. I would definitely
do some research and find a surgeon that accepts your insurance and has the
other qualities you are looking for. While I have no doubt that BTC is a
desirable program, they are not the only experienced bariatric surgeons. I
would first go to the "find a doc" page and follow the links to
your state's surgeons. Click on each one and read what insurances have paid
for their services. See if yours is listed. Next, call the surgeon and see
if they accept your insurance and finally check with your insurance
company. Many of these doctors have comments posted by members. Check them
out and e-mail them any specific questions. I hope you are not too
discouraged. I also had the same experience with the BTC in Ohio, and just
continued my research. They might be the first "organization"
that comes to mind, but they are definitely not the only fish in the sea. I
found my wonderful surgeon this way and am so glad I did. BTW, I agree that
they should have told you this BEFORE taking your consultation fee!!! Good
luck to you and don't give up or plan to wait until June to start the
process. This doesn't have to slow your journey much. Shelley
— Shelley.
February 13, 2002
I agree with Shelley on BTC. I am NOT in any way saying they aren't
excellent. I don't have any personal experience with them. But there are
probably doctors near you and in your network who are also excellent.
Going to the Find Peers site and looking at who others in your state have
used can be very helpful. Changing insurance just to be able to go with
BTC rather than someone else may not be as good an option as it sounds. As
to pre-existing conditions clause, that is probably governed by state law.
Contact your state Insurance Commission (or Insurance Divison, it varies by
state) and ask them about it before you switch.
— garw
February 13, 2002
Connie, best of luck to you on this. I suffered a similiar experience. I
loved my Surgeons, but they were not in any network. I looked into other
groups, and other insurance, but I decided to stick with my original
surgeons. It was just a matter of comfort for me. It also meant $7800 out
of pocket UP FRONT. BCBS will pick up the rest. The hospital is network, so
I am good there. I did borrow the $7800, which I realize is not an option
for everyone. Like a previous poster said, check this web site for Doctors
in your network, and email those patients listed. I found that they all
willingly wrote back with input. Get to a support group and ask those
patients, if that is an option for you. One word of advise on
insurance...as I was told by an insurance rep...DO NOT SCHEDULE Surgery or
anything medical, as it may cause the new company to deny you. I don't know
if this is always the case, but it does happen. I wish you the best of
luck.
Michelle
— Michelle P.
February 13, 2002
Donna NO that is NOT the case. With my bc/bs I have the option of going out
of network. (My co pay will just b somewhat higher) but BTC does NOT ACCEPT
my insurance of bc/bs pos. MY insurance WILL cover 80% of out of network
and would allow me to go there, I spoke with Sue from the BTC AFTER my
consult and after being assured by Amy at the BTC that my insurance would
cover it. They were right, my insurance would cover it but THEY NO LONGER
accept bc/bs pos.
— Sassy M.
February 13, 2002
Connie I don't know about you, but if my doctor had me come in and pay a
consult fee only to turn around a tell me that they don't accept my
insurance....a POS does enable you to go out of network like you said, I am
under the assumption that BTC must not like the payment that your insurance
company makes, either way if you insurance company covers it and they don't
accept it, it kinda sounds like discrimmination based on insurance.....just
food for thought
— Jeff B.
February 14, 2002
Connie, I understand your frustration. I'm not sure if you had your heart
set on BTC, but, I had my surgery through Dr. Kevin Krause at Beaumont in
Royal Oak. I have BC/BS Community Blue, PPO, and they covered it 100% with
Dr. Krause. He didn't charge a consult fee, or anything. If you are
interested in anymore information, please contact me via email!
— Chloe S.
February 14, 2002
Hi Connie--I am new to this website, but I was browsing the postings and I
think I may have an answer for you! I too have Blue Choice POS and I had
my surgery through The Hurley Center For Comprehensive at Hurley Hospital
in Flint, MI. I had no problems. You should call them and get some
information, I know my surgeon was in-network! I didn't pay a consult fee
because it was billed to my insurance company. Everyone is very kind
there. E-mail me for their telephone number!----Jen
— Jennifer H.
February 14, 2002
Dr. Kevin Krause -- 248-551-8180 -- He is at Beaumont Royal Oak and is
absolutely wonderful. He does Lap RNY and is just awesome... BC/BS covers
100%!! Yesterday was my two month anniversary and I have lost 98 lbs!!
Give him a call... I think he is much more compassionate and concerned that
anyone at BTC!! Good Luck and email me if you want more info!
— Sharon M. B.
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