momma_missie

I met with my surgeon to be for the first time on Saturday. I attended a seminar on Saturday and afterwards those who were seriously interested in had their initial consult with the surgeon afterwards. I met with him for about 30 minutes after the seminar. (Before the seminar I was weighed, vitals taken, etc.) He told me that based on my insurance requirements I was eligible for surgery, all that I needed was a psych eval. He told me I would be a great candidate for either the sleeve or RnY procedure. The nurse came in after he had left with some additional information for me to read over, told me that the insurance/patient advocate would be contacting me by Tuesday or Wednesday and told me that if I wanted to complete my psych eval right then and there that I could do that. (Which I opted to do and was so thankful for.. no time to stress over and worry about it!)

Following.

I was so excited last night when I was able to attend my Weight Loss Surgery seminar. I loved the staff I was able to meet from the practice and I found out that with a BMI over 50 that BCBS waives the 6 month mandatory supervised dieting. Both were great pieces of information. Today I called my insurance company to begin asking several questions from the surgeon's office that I needed to have done by the time of my 1st appointment. The end result was finding out that I don't have a $6600 individual out of pocket maximum to pay, but instead I have a $13,200 out of pocket expense maximum I could potentially face because I have a family plan through my employer. I have a co-insurance maximum of $6,000 I could potentially pay. (Which would be applies towards my total out of pocket expense if I surpass this dollar amount.) I have a 50% co-insurance due for any bariatric procedure and I have a 50% co-pay for the surgery portion of the procedure. So I figure I'll easily be out the $13,200 for the year. Initially I was sad and very angry. Now I have calmed down and am trying to wrap my head around how to come up with this kind of money in order to move forward with my WLS. I plan to call my hospital and surgeons office tomorrow to see if/what they offer in the way of financing, etc. I was just curious as to what others did that faced a large out of pocket expenses in order to have their surgery. Just FYI I have BCBS of Michigan.

@@emilybee Do you have an out of pocket max for the year?? My family out of pocket max is $13,000, but my individual OOP max is like $6600... which doesn't seem too bad all things considered. Good luck to you! The journey to getting to surgery is emotional enough.. surgery itself.. I can't imagine what that day will feel like when it arrives!

It is encouraging and refreshing to hear a positive insurance story! Congratulations!!!

I have no advice or experience with even a similar situation.. just wanted to tell you to keep strong and keep fighting. I can't imagine the heartbreak you must be experiencing, but stay strong! I hope and pray that you are able to have surgery after all the misleading information you have received. Thoughts and prayers are with you during this struggle!

@@MsAlaineus I'm also from Michigan and have BCBS. Just checking in to see how you are doing, what the turn out was, etc. I attend a 2nd seminar on June 13th. This one will be at the Barix facility down in Ypsilanti, MI.

@@brandnewending I am attending a seminar down in Ypsilanti on June 13th. My dad had his lap band surgery done here about 5 months ago. I'll be meeting with Dr. Taylor afterwards. Just wanted to check in and see when/if you received a surgery date and how you are doing today! How was your experience at Barix? They have confirmed that there will not be a 6 month waiting period because of my BMI and my insurance. That part is encouraging. Now to figure out the financial aspects of it all as well. I'm getting very nervous and excited.

I have scheduled to attend a weight loss seminar at a local hospital on May 18, 2015. Is this the first step to beginning the road to WLS? Should I have met with my primary physician before I do this? I currently have BCBS of Michigan through my small (less than 50 employees) employer. They will only cover 50% of the surgery as far as I know. When I called BSBS they didn't have anymore details than that to give me. My BMI is approximately 53. Anyone have any advise, suggestions, experiences to share, etc? I am just looking to figure out what to expect next, what kind of timeline I might be on before surgery were performed, etc. Perhaps someone here has some info. to share.

I went to the seminar locally on May 18th. In order to even make my 1st appointment there was a huge list of questions I was required to call my insurance company and get answers to. Hah.. BCBS wouldn't give me an answer one! So... after reading online and talking to many friends I decided to look at surgeons and facilities elsewhere in the state. So on June 13th I head down to Barix Clinics in Ypsilanti, MI. My dad had his lap band done here about 5 months ago. On the 13th I'll attend another seminar AND have a face to face consultation with the surgeon. Nervous and excited all at once!

I think you can have sleep apnea, but it has to be diagnosed and being treated with CPAP for then to do surgery. I have a friend who had to bring her machine with her when she had her surgery.

I have made an appointment on June 13th do go through a seminar and have a face to face consult with a surgeon at the Barix Clinic in Southern Michigan on June 13th. I can't wait!! They will handle the insurance and help to get me financed to cover the out of pocket of the surgery from my understanding. Most areas around here is about $16,000 for surgery. I'm still hoping that my deductible will only be $6,000. It would make me feel SOOOO much better and at ease. I'm not giving up yet.

So glad that I found this thread!!! I have tried lessening the computer and research time in the last week or so because it was consuming ALL my free time. Haha. I attended a WLS seminar at a local hospital earlier this month. I was very discouraged when I was given a list of questions I needed to have my insurance company answer before they would schedule my first appointment. I say discouraged because my insurance company told me those were all questions my doctors needed to be asking, they couldn't give me specific answers. For a day or two I was sick, nauseous and ready to give up. It was one night before bed that my husband said "Why don't we just look for doctors downstate? I'll travel for great customer service and for the doc's office to do their job with the insurance companies." It was like the light bulb came on. I contacted Barix Clinics in Southern Michigan because my dad had his lap band done here about 5 years ago. I attend my seminar there AND have a face to face consult with the surgeon on June 13th. (A Saturday so no extra time off work!!!) The lady I talked to said that by Monday or Tuesday they'd have information from my insurance company on what else was needed and they would work with me on financing my out of pocket financial responsibilities. So... time seems to be standing still. Glad to have others to share the lack of patience with!!

Anyone here have a personal experience with Barix Center in Michigan? My father had a lap band done there 5+ years ago and his surgeon is no longer there, so I am scheduling my seminar and initial consultation with Dr. Taylor on June 13th. I am excited and nervous. I attended a seminar locally and wasn't impressed with how i twas my job to chase down information from BCBS that they weren't willing to give me in order to even schedule an initial appointment. Just looking for others opinions on the center and/or doc.

@@kimpossible67 How was your experience with Dr. Taylor? I'm looking at scheduling a consult with him in June.

I was under the impression that my portion was all that had to be met, because after all, I only had to meet my $500 individual deductible before they started covering my other doctor appointments and such. But BCBS today claimed that I had to meet hte family out of maximum before they would pay. Mind you, neither person I talked to really had any clue about anything. They would just repeat what they were reading off to policy word for word to me. It wasn't helpful at all and they told me my surgeon could call and get more answers than I ever could get.

Who does your support system consist of on this journey to a new and better you? My mother in law is attending my seminar with me, but she keeps pushing me to do the Ideal Protein stuff. I keep hoping my husband will come around to the idea of surgery, but he continues to tell me I am crazy. No other diets I've used before have lasted and I'm just expecting a miracle cure and this won't work. Makes me sad and angry. On a positive note, I have my parents (my dad had lap band done 5 yrs.ago), a close friend who also had the lap band 7 years ago, my sister who lives 1500 miles away, and two amazing neighbors to keep my @$$ motivated and on the right track afterwards. I've also got support here and on a couple of other message boards and forums. I'm determined to prove all my doubters WRONG!!

So glad to have come across this thread!! I'm just starting the WLS process... I'm 5'11 and currently weight 376lbs. I've made my mind up that I want to have the sleeve done.. I just hope when I meet with the surgeon that he agrees!

Who does your support system consist of on this journey to a new and better you? My mother in law is attending my seminar with me, but she keeps pushing me to do the Ideal Protein stuff. I keep hoping my husband will come around to the idea of surgery, but he continues to tell me I am crazy. No other diets I've used before have lasted and I'm just expecting a miracle cure and this won't work. Makes me sad and angry. On a positive note, I have my parents (my dad had lap band done 5 yrs.ago), a close friend who also had the lap band 7 years ago, my sister who lives 1500 miles away, and two amazing neighbors to keep my @$$ motivated and on the right track afterwards. I've also got support here and on a couple of other message boards and forums. I'm determined to prove all my doubters WRONG!!

So glad to hear that you've found a surgeon that you are happy and comfortable with!! Hope that all goes well and your surgery date is here before you know it!!

*hugs* I am SO sorry that you had this experience with "family". You, nor anyone else deserves the negativity because of the decision you made to take control of your life and your health. It's so easy for us to pass judgement on others when we really have no idea what a day in their shoes is like. I try my best to not judge, because I've not walked a day in someone else's shoes.. but with that being said, I am NOT perfect. I encourage you to go back and read journals (if you kept any) and/or remember why you made this decision. Think about the work you did to work up to the day of surgery, the patience, tears, frustration and pain you dealt with after the surgery... remind yourself it was far from the "easy way out." You've worked HARD to get to where you are today!! Keep your chin up and surround yourself with a positive support system to help get through the tough times with difficult people.

Loved your post. I had thought of all the reasons I "need" the surgery, but I didn't dare think selfishly about why I wanted it. I guess shame was holding me back.. your post was eye opening. (okay.. it made me giggle a bit too.. haha) What an amazing husband and father your wife and children have! Keep us updated on your progress!

I'm from Northern Michigan as well! Just curious as to whether or not you moved forward w/ surgery.

I was just recently "officially" diagnosed with horrible sleep apnea. As stated before, the machine takes some getting used to, but it's amazing to feel rested in the morning once you get used to it!! And yes.. it should actually help your chances at getting surgery. It's considered a comorbidity (sp?) I believe.

How in the world did you get through the process so quickly?? Are you self-pay?? Either way.. congratulations!! That is awesome you are moving forward to a brighter future! How in the world did you get through the process so quickly?? Are you self-pay?? Either way.. congratulations!! That is awesome you are moving forward to a brighter future!