lolamadora

I am new at all this and recently found out that although my insurance is with anthem blue cross of califrnia PPO that blue cross bears no liability in that they simply administer the plan. My insurance is self funded by my husbands larger employer who at the beginningof march 1, 2012 was still working out the specifics of the SPD and thus could not provide me the detailed description of what specifically they covered in regards to bariatric surgeries...it just says that bariatric services are not covered if it is not medically necessary. I called 1800 thin here in California. I have been seen at Dr Johnson's office where I have had a sleep study done, upper GI, ultra sound of my abdomen, and bp taken,weight,labs. The office is clearly efficient and told me I meet the core mobilities being that I have high blood pressure, sleep apnea, and a BMI of 38.5%. Has anyone delt with insurance that is self funded by an employer? Seems wrong that my insurance began jan 1, 012 yet they are still.having a team of lawyers iron out the details of the SPD. I also found out that the governing agency over these types of plans is a Federal agency which name escapes me and I was told that basically they could get away with never showing me the SPD....I work in the medical profession and I feel blind sighted by all of this. I am just wondering if any of you have ever dealtwith this..Thanks in advance;-)

Thank you for your information Aspiring avangelist I did not know this and that makes me concerned. I did look up the doctor in the California Boards also found him licensed in two other states he has been doing laproscopic procedures for what appears to be some time. I found it interesting that they are a one stop shop everything is done in house...the sleep study, endoscopy, ultra sound. I have yet to be billed they just keep telling that my copay is 1,000 from start to finish. I did have a chance to see the surgery center which is a 1 block distance from the hospital. That being said I have spent two weeks trying to get my sleep study results. I have yet to get any information only that they received prior approval before I had these various procedures by the insurance company. I went to see my primary doctor today and he was a little concerned that they were not offering the results. I don't know what to think. My point of contact for the office she is very slow at responding to emails and I am starting to get some red flags. LBT addict, wow! did not know they were having law suits and such. When you say band providers are ending their relationship with them what does that mean? Does that mean the doctors that are with 1800 thin are leaving the group? Junior Guru is the practice you go to part of the 1800 thin group and thats amazing the doctors answer texts? That would be a 6 hrs drive though to get to Santa Ana but it would be nice to have a doctor recommendation for the Bay Area for the fills. My doctor also recommend the sleeve but I would much rather have the band and still want to proceed. I don't mind taking the time to research all this out I have been overweight for a long time what is a few more months! LOL! ...