Rocket City Guy

Hi Jason, Justed wanted to tell you to keep trucking and not let any of these obstacles slow you down. I know from experience that sometimes you have to be aggressive with the Neoami and the insurance company. I hope you have smooth sailing from here on out and good luck!

I had the 5:15 appointment time too, and had to drive from Huntsville, which at that time of morning is probably an 1:30-1:45 min drive. They took me back almost right away, but I cant really recall exactly what time the surgery started (I'm sure Dr. Schmitt's office folks could give you an idea). I was home by 2pm though, I do know that. Congrats and good luck!

Flowergurl, I really think FEP BCBS benefits are the same nationwide, taking into consideration whether one has the basic option or standard option. I think where some of the differences some of us have experienced are due to the way hosp and dr's bill for the operation. You mention your copays after deductible for the doctor and for the hospital, but do you know if you will be billed for the band itself? I myself was, and since the hospital billed it instead of the doctor, I was responsible for an additional copay of 30% of the allowable charge, as the band system is considered durable medical equipment...if my surgery had been inpatient instead of outpatient, I wouldnt have been responsible for any additional costs for the band. Going from what your post said, it sounds like you have standard option bcbs, so if you are billed for the band system by the hospital instead of doctor, you will have to pay 10% of allowable for that. So I guess I'm just trying to say its not just that we need to read our plan brochures (which we do!)...there are many different factors that can affect how our benefits are applied

You have mail. Good luck!

[quote name= From my experience with FEP BC, surgeries have a $100 co-pay, as well as a $100 copay for the facility. I'm concerned that there might be a difference in how the actual band is covered under in-patient and out-patient surgery. I plan to call BC to ask on Monday.[/quote] Pennyt, Please post what you find out. I have Fed BC/BS, basic option, and had my band placed back in Feb. I had a $100 copay for the surgeon, and a $40 copay for the hospital, but like you mention above there is a HUGE difference in how the band was covered for my outpatient surgery (70%) vs. how it would have been covered if my surgery had been inpatient (100%). It ended up being almost $1600 copay just for the band! If anyone reading this has fed bcbs basic option and had their surgery done outpatient, please post and let me know how your band was covered, if it was different than I described above. Thanks!

I'm at work and dont have my EOB in front of me, but I know for a fact I would have been much better off to have stayed overnight, financially speaking. The band itself was the largest charge by far. It was billed as durable medical equipment, which for outpatient surgery is only covered at 70% by my insurance (Federal BCBS). If I had been inpatient, it would have been covered 100%. Do a search on my previous posts, I think I have posted more detailed information. I will try to remember and bring in my EOB and will scan it in if possible. I do now that others with the exact same type of insurance have paid less than I did...still trying to figure out that one!

Just a quick caveat on this...in order to get a tax benefit from this surgery, or any surgery you must file an itemized return and you can only claim the medical expenses that exceed 7% of your adjusted gross income. That said, you can include mileage or airfare to the doc, hotel rooms, etc, so save all associated receipts!. For more info, please see http://www.irs.gov/pub/irs-pdf/p502.pdf

In hindsight I wish I had shopped around a bit too before choosing Miles/Schmitt. Their main selling point to me is their experience with the band, but since I began my journey I've discovered that there are other docs with almost as much experience that are closer to me. Also, sometimes with Miles/Schmitt's office, it just kinda feels like an assembly line, kinda impersonnal or something. NOT that everyone isnt super nice there....it just seems like they have so much experience with the whole process, and they dont realize every step is a new experience for the patient. Anyways, good luck with everything Michelle....and I completely agree about the sleep apnea deal.....so ridiculous!

2. I only use an urgent care clinic if I get sick, I havent had a "family doc" in 10 years or more. I just hope he will accept the records from a clinic. Im not sure how this will if you have a letter from a primary care doctor. Michelle, I was in the same boat. I very rarely get sick and have always just went to an urgent care....this was not a problem, in fact, they didnt request past records. As far as getting a letter from a PCP stating that I was fit for surgery, I just found a doctor that was accepting new patients, went there and explained my situation and that I would like him to be my PCP from here on out. He didnt have a problem with that, just said that in order to write the letter he would have to do a physical exam and some blood work in order to do so. He even worked with me on how to bill it so that the needed test were covered by ins. If your interested, the guy I saw is Dr. Plotka at Phoenix Urgent Care.....

I never thought that I had a sleeping problem either, but the test showed I had mild sleep apnea and I was prescribed a CPAP....and I never used it past the first 30min on the first night. I did not have a clue that it had a data card in it! I almost had a heart attack the first time I heard someone talk about one of those and really got lucky that my sleep doctor did not require me to bring it in or anything at all. I really think my guy was kinda a quack to tell the truth lol. For example, I kept telling him Dr. Schmitt required him (the sleep dr.) to write a letter saying I had been evaluated for sleep apnea and was being compliant with prescribed treatment.....buy the sleep doc just kept sending the results of the sleep study, with no letter or comments. Thank goodness that his receptionist took pity on me the 4th time that happened and made sure it was handled!

What you were told is correct, everything is COVERED...but the way things are covered differ between inpatient and outpatient. I dont think Dr. Schmitts office can give you a breakdown, b/c they dont bill for the hospital. The way I was billed was one bill from Dr. Schmitt for the surgery (covered at 100% with only a small copay to deal with), one bill from the hospital (multiple line items on this bill, everything from different meds to the band itself, to the recovery room. Many of These items were only covered at 70% due to outpatient status), and finally the anthesia bill, which should be covered at 100% no matter if surgery is in or outpatient. I'm speaking from MY own experience. You should call BCBS and get them to explain to you how your benefits differ between in and outpatient surgery. The part that I guess threw me for a loop was I thought I would only be charged the $16K or so they quote at the seminar as the cash price, and that benefits would apply to that. If you have insurance, that is NOT the case, there are MANY seperate charges and thus all of the different rules by which insurance will apply. BUT at least we have insurance, right? I bet that is as clear as mud, right? Send me a pm if you have any specific question. I really wish I had went with Dr. Kim Schmitt. It sounds like she was much easier to see than the folks I went to, even factoring in a two hour drive one way to get to her :biggrin:

Sorry, I may not have been clear in my last post. The anthesia is covered 100% inpatient or outpatient. But they give you other drugs, such as anti-clotting medicine for example, that are only 70% covered for outpatient.