stuffystephie

Anyone have any recent experience with a lapband surgery ubder anthem bluecross in ca with an hra/fsa ppo. Ins covers at 80% once deductible is met...and i have to go through the center for medical excellence?? We r switching to anthem effective jan and i want to start the process asap.

Ooh ooh ok so...i have a couple questions lol...forgive for sounding dumb here if i do...now by qualifications u mean requirements to get the surgery?? And the deductible would end up being met with the cost of the surgery correct?? We have an hra with our policy so its used to offset the deductible and we have an out of pocket max of 8k which when met we are covered at 100%...so once all i said and done and they determine i would have to pay 8k or more it would be fully covered right...or do i have to pay that?? I elected for an FSA as well of 1500.00 its not a lot but we are only allowed a max of 2000.00 for our FSA... I tried calling anthem but they wont discuss it with me because we arent active in their network til jan but i wanna start getting my ducks in a row now...this may put me in a huge debt but it will also help to save my life so i would rather be in debt than dead :-/

What does it all entail? I know the basics see a nutritionist and psychologist n whatnot but like is there a general diet they put you on and how often and how long each time do you have to see the nutritionist?

Oh ok because i have a documented lifelong struggle with obesity dating back to childhood ive done diets gyms doctors you name it ive done it this is my last hope...for me and my daughter.

Once there is insurance approval does it usually always take about a year to actually have the procedure done or can that vary depending on the surgeon as well?

A good substitute for mashed potatoes is steamed cauliflower. Get it really super soft and thrn mash it up and add some milk or sour cream for a bit of a consistency adjustment and whatever seasonings you like...it will taste just like mashed potatoes and you would never know it was actually cauliflower and way healthier for you.

Is there a general cost on the surgery for the band itself or does it vary based off the doc and the hospital...im just trying to get a general idea of cost really... What kind of diet do they put you on in the months prior to the surgery or is that something you just work out on your own?

So to start this off im 27 and a single mom to a 9 month old princess who is the absolute apple of my eye. She is the whole reason i have decided to finally have the surgery. I am all she has and i cant quite see myself keeping up with her at 260lbs. I have been considered obese since i was a kid...done everything u can think of to lose the weight too. In any event i just found out that i have high cholesterol now as well. I have anthem blue cross as of jan which covers bariatrics at the centers for medical excellence. We have an hra plan with an fsa as well. My ins covers me at 80% when deductible is fully satisfied....anyone have any experience with anything like this?? I set aside some funds for the fsa to specifically help with the surgery but struggle financially as it is but i just know this is something i need to do to get my life back. Any advice or info would be helpful... Would they speed the process up since i already have some significant health risks due to my weight??

Was everything done within network and did u have an hra as weell?

Ok well now it makes a bit more sense to me i thought the out of pocket max was in addition to the deductible as in a separate cost kind of thing. Being that i have spent my entire life (from roughly 6yrs old) being obese i think its time i for a drastic change and i know from a few people who have had it done who say it basically teaches you how to eat all over again more less....which i think would do me good. I honestly eat pretty healthy foods and i do drink a ton of water so i just dont know what else to do. Thanks for the advice tho. I appreciate it :-)

Ok so my in network out of pocket max is 8000 and i have a 3000 deductible which would easily be met with the cost of the surgery and my hra...but the deductible counts as part of the out of pocket max? Im not very good with this insurance stuff at all i am trying and still learning but i think im getting better... Its just really tough to be able to do a lot of things like exercise when half my day is spent working full time and i have my daughter 100% of the time as well so i need to go home to be with her and be in bed by 8 so i can be back up by 5 to start all over again...lol...

My bmi is definitely far over 40 im at 47 and i have high cholesterol now too which i just found out today from doing my biometric screening...i have an hra/fsa ppo plan with a 3000 deductible but the surgery cost alone combined with my hra will meet my deductible. But being that its something that would be potentially deemed medically necessary would my ins still only cover me at 80% or would it be fully covered?? They wouldnt go beyond what my plan allows right?