shancanssleevejourney

Thanks for the clarification and you are still doing amazing. I feel a little better now lol

I'm confused, you said you started the journey in January, so I am assuming you lost before surgery? How much did you lose after surgery. 90lbs is amazing no matter when you started, I am just celebrating my 3 month and I am almost to 50 and know I will never lose 40 more in two months so just jealous lol. Congratulations on being so successful.

Once you are authorized you are good to go. I had lost 9lbs prior to surgery and did drop 1 bmi point. It doesn't matter if you lose after the authorization. It's only to document.

I regret I use the term usual and customary it apparently caused a lot of confusion. I was given no set fees for anything I was just told a percentage.

I have no idea how the post above this went weird lol: I do have an out of pocket max but they say this surgery is excluded. I know usual and customary doesn't apply to most cases. I am just trying to find out what blue sheild of CA would normally pay if my employer group did not put this addendum in place

I do have an out of pocket max but they say this surgery is excluded. I know usual and customary doesn't apply to most cases. I am just trying to find out what I know usual it customary doesn't like to know skates is. I am just trying to find what they would normally pay if my employer group did not put this addendum in place

Thank you for responding, unfortunately it's true. I have spoken with all parties involved. There is a secret squirrel lifetime max pay out that no one has anywhere in our paperwork but it does exist. My fight will be based on not being properly informed of this limit. I am feeling more confident that this will be won based on that alone. I just was hoping that someone could give me what they were billed and what the co-pays were so I can use "usual and customary" as another tool to fight with.

Fighting a losing battle over insurance coverage. I was told one thing and billed completely different. I am in desperate need of anyone who would be willing to help me understand what they were billed, what was covered and what was not. I think they are pulling a fast one because we have Delta Health as our plan manager and they are both pointing fingers at each other. I need a baseline to see what is usual and customary for them to pay for the surgical supplies,operating room and overnight stay etc. If you want to do this privately please send me a fb message. https://www.facebook.com/shannon.vanhoosancannizzaro

The Hospital and Surgeon are in network. Nobody will take responsibility for not telling me. Everyone is saying it's my responsibility to fully understand my benefits. It's an "addendum" that was never disclosed. How the heck would I know to ask if there are any addendums?

I have already called and talked to the insurance and they claim it was a maximum of anything "connected" to the surgery, but I was never informed of that. The 32,000 is after the "contracted" amount and the 16,000 applied. The original bill was over 55,000. and also my Surgeon has an additional bill to me for 2800. on top of the hospital bill.

I went through every step that my insurance required. The 6 month medical supervised nutrition counseling. All the tests required including pysch eval. I was told my surgery was covered up to 16,000 for a lifetime max surgery pay out. No problem, my surgeon office told me it was 18-20,000 so I figured worst case scenario I would owe 4,000. The hospital just sent me a bill for 32,000.00. They said insurance only covers for entire cost including hospital stay. I would have never done this surgery had I known. I am devastated and don't know what to do!

If I were a betting person @@AmberWarstler I would put money on it being cycle related and possibly a hormone issue.

Could you possibly be close to your cycle amber? I gain about 3-4 lbs in water weight around my cycle.

Yes please send me a friend request. Because it's a secret group it's the only way

I will get you in shortly. Love to have you