Candle

LOL!! I know what you mean. Yesterday I went to the pulmonary doc, then she sent me to the hospital to get a chest x-ray. I also went to the nutritionist and to the cardiac doc for an EKG and ECHO. I have to go do the stress test on Sat. Next Mon I am seeing the shrink (and the dentist) and Tues the doc for the upper GI. Plus, I still have to do the sleep study and see the pulmonary doc again to review the results. As well as my regular PCP for 3 more of the 6-consecutive-months I need for the supervised diet. Good grief!!!

Luckily, mine is the same price, so my employer agreed to switch the plan for me but the coverage isn't as good as what I have now. They call it a hospitalization plan. Meaning they cover testing - hospitalization - surgery - etc but not the fee for office visits. I'm trying to get all the pre-op tests done while I still have BC/BS. LOL!

I have Anthem BC/BS there's an exclusion on my policy too. I am canceling and taking out an individual plan with GHI (I think they are only a NY company) They cover the band and as long a there's no gap in coverage I'm told I don't have to worry about the weight being a pre-exsisting condition. I'm not completely convinced this is going to be as easy as it sounds but we'll see in a few months when I finish the doctor supervised 6 month diet and we submit to the insurance company ... *fingers crossed* Between co-pays, the shrink and tests not covered by insurance, I'm out about $750 out of pocket. I'm going to freak if GHI doesn't cover it. Plus I'll be stuck with their crappy plan until open-enrollment in Jan for my regular BC/BS policy.

I'm waiting for the sleep center to call me to schedule my sleep study. I'm a little nervous because my doctor scheduled a follow up appointment to go over the results of the sleep study, in 8 weeks. I hope it doesn't take that long to get an appointment. She said if I have apnea at a more than mild level I have to get a CPAP machine and do a second sleep study. Ugh!!

I just went today. They had me do all these breathing exercises and now I need to go to the hospital and get a chest x-ray. I'm waiting on the sleep study appointment(s).

How did your insurance company handle the doctor bills for the pre-op tests? The sleep study, cardiac evaluation, thyroid testing, etc ... did they cover those things because they are tests that could have needed to be done anyway, since you are over weight? Or did they deny the claims because they were pre-op tests for "bariatric surgery" I know I have an exclusion and I don't want to find out down the road BC/BS won't cover these bills. (I am switching my insurance co before the surgery. A policy that covers it.)

Just got the explanation of Benefits letter on my surgeon consult ... I only had to pay the co-pay of $30.00!! Woo-Hoo!!

I hate to say it but I'm giving up the insurance battle ... really before it began. Thanks for all the advice and info from everyone here. I probably won't be visiting this site any more ... I think it's depressing me even more and I'm getting very jealous (and dare I say bitter) when seeing people complain about having to do the 6 month diet or pay a co-pay or or or ... Anthem BC/BS won't cover the band since it's an exclusion w/ the small business plan. I contacted a few lawyers and other than send me paperwork to fill out and a BILL, can't really get them to talk to me and give me any REAL information and/or odds on beating the insurance co. I big fat BOOOOOOOOOOO to all those lawyers who advertise they want to help you and have the band themselves .... if they really wanted to help, why I have I not gotten ONE call back in two weeks?! My employer said if I wanted to purchase an individual health plan they would pay $400 per month of it (that's what they pay for my BC/BS plan) and I'd pay the difference. I've only found one plan for less than $750 per month here in NY. It was with GHI and only $415 and they cover the band but ........ they don't cover doctor visits .... no co-pay or deductable ... they pay $0. What the hell is that? If I just get sick, have any complications, etc they pay nothing?! I called 2 doctors today and s/w the insurance person in their offices and both recommended NOT even trying to start the process with the intention of trying to fight my insurance co through appeals. (since it's an exclusion on my plan.) I guess they are right. Why pay for all the up-front doctor visits, 6 months with a nutritionist, seeing a shrink, etc to only be denied anyway? If I buy one of the expensive plans there's no guarantee I will get approved for the band. I doubt it would be a problem: I have a BMI of 48 and a number of other health issues. I'd have to jump threw hoopes and between co-pays plus the extra money every month for the policy - I could get the band in Mexico or CO for close to a year or two of those fees with no hassle. If I purchase the cheap policy w/ GHI or try and fight BC/BS, it will be pretty much the same thing since doctor visits aren't covered. Self pay is not an option right now since we wiped out our saving buying a house (that still needs some work) last year and I already have credit card bills that keep me up at night. I've done about 6 months of research on the band and really had to talk myself into accepting that I need some help getting my weight under control - under permanent control. Kinda surprising since I've been overweight my entire freakin' life - lol. It never even occured to me that my insurance company wouldn't cover this. I feel like going to the doctor for every little sniffle now to rack up the bills they have to pay for what IS covered -lol. Back to WW on Monday I guess ... Thanks for listening.

I've got a few apointments coming up. *fingers crossed*

I'm so overwhelmed!! <O:p</O:p My job has been understanding so far but that patience is going to wear thin soon!<O:p</O:p <O:p</O:p Time off for:<O:p</O:p <O:p</O:p Surgeon consult<O:p</O:p Upper GI consult - then another appointment for the test<O:p</O:p Nutritionist<O:p</O:p Shrink<O:p</O:p Pulmonary Consult - then another appointment for the sleep study<O:p</O:p Cardiac Consult w/ EKG & ECHO - then another appointment for the stress test<O:p</O:p An appointment each month w/ my PCP for the 6 month diet<O:p</O:p <O:p</O:p Plus I just had some major dental work done to be sure my teeth are in perfect shape – chew-chew-chew. That’s been 4 appointments in the last 8 weeks!<O:p</O:p </O:p How do people who work a regular 9-5 M-F job do it? :help: <O:p</O:p Going to Mexico is looking better and better - lol</O:p <O:p</O:p

I was just at my doctor on Tues and home was 7lbs less than at the doctor's office.

This is the reason for the exclusion on my plan (out of CT). Not my employer's "choice". (I bet it’s an EMPLOYER exclusion in the majority of cases though)

Anyone else?

Thanks I'm trying to work magic with the scheduling. lol

I can't see why an MRI would be a problem. The only thing that really messes up an MRI is steel or metal, right? Because of the magnets involved. I've had spinal surgery and have steel rods in my back so MRI's don't really work for me. I know if the rods had been titanium an MRI would be fine.

Wow! $1600! It's really amazing how everyone's experience is so different! Seems like every doctor does something different.

I haven't been banded yet but my doctor's fee for surgery includes the first 3 months of after-care and fills. I thought most did the same - free for 3-12 months. After that, I will have to self pay for my fills and doctor visits ... $75.00. My doctor doesn't do fills with fluro regularly but if they need to, I think they said the fee was $225.00 I live in Long Island, NY ... I thought THIS was the most expensive place on earth - lol. You are in NJ? In all my research I have never seen anyone say their fills were $1,000.00!!!!

As I posted in your other thread - I have Anthem as well but there's an exclusion in my policy so they cover nothing The first 2x I called Anthem they told me they DID cover the band then when I called to get details on requirements and if I needed the 6 month diet, they finally got it right and told me I'm NOT covered. Make sure you give them the CPT code and get a definite "YES, you are covered." Good luck

I agree completely.<O:p</O:p <O:p</O:p All the problems I have encountered with insurance have been making me think about once this is all over, looking into ways to help fight insurance companies from excluding/not covering WLS surgery.<O:p</O:p <O:p</O:p Fighting for change in insurance procedures is probably a lost cause but there has to be a way to make them realize that in the long run, it's cheaper to provide coverage for WLS than to pay for all the mental and physical ailments, diseases, disorders, medications, etc that are related to obesity.<O:p</O:p

Where do you live? That will play a role in how much the surgery costs. (In most cases) <O:p</O:p <O:p Are you in CT? Someone on this board was telling me about a doctor in Hartford who only charges around $11,000. I checked and he's on the Anthem physician list. (I don't know anything about his experience or reputation though) <O:p</O:p <O:p</O:p Seems like on average the surgery is any where from $18,000 - $25,000.00. Plus or minus about $5,000 <O:p</O:p <O:p</O:p I would call Anthem [ :rolleyes aren't they just soooooo pleasant and helpful? :rolleyes ] and ask them to explain exactly what that mumbo-jumbo means. Sounds like you'll end up having to pay the full $2500 <O:p</O:p <O:p</O:p Self pay can be as cheap as $7500 in <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:pMexico</ST1:p</st1:country-region> or $9950 in <st1:City><ST1:pDenver.</ST1:p</st1:City><O:p</O:p

Let me know if that works out for you - I may be in the same boat if insurance doesn't work out. I will have had all the pre-op tests completed before I know if I am denied.

capitalone.com > tab for: health care finance > cosmetic http://www.capitalonehealthcarefinance.com/cosmetic/ Quite a few people here have used Dr. Kirshenbaum in Denver. There's a huge multi-page thread on him in the doctor forum. Good luck (remember to write off your medical expenses on your taxes next year!)

I have Anthem as well but there's an exclusion on my policy, so they don't cover anything Did you ask if they cover fills? (I forgot to ask that)

Sorry - I feel kind of stupid but ... Within a post, how do you copy the text? When I highlight the text > right click > there's no option for CUT or COPY. I don't see an icon in the toolbar for this either. I wanted to cut and paste a few recipes I found in the food FORUM to add to my personal cookbook I have saved on my PC. Thanks

I've watched a few proceedures on or-live.com and in each one, the doctor stood on the side - not between the legs.