Out-Of-Pocket Costs

[Alisomniac 0]

I just got approved for my surgery (no date yet) via Federal Blue Cross/Blue Shield HMO and was wondering my out-of-pocket costs... so far it has all been co-pay only.

If I'm reading my plan right, I have a hospital co-pay of $100. But I'm pretty stupid about this insurance stuff, and I think I would explode if it was all of a sudden a ton of money -- mostly because I live paycheck to paycheck.

Any costs that I'm not foreseeing, or since I'm approved by insurance, will I just have co-pay, hospital co-pay and possibly individual co-pays to the surgeon and the anesthesiologist?

[persian_girl03 0]

i wish i could give you an answer... but from what i know and from whati've heard if you do want to pay out of pocket it's about 15-20k

Now, since you have been approved through you Insurance then i would imagine since it is a HMO you would only have to pay the COPAY.... if they do raise the question of how much you have to pay out of pocket i would call the insurance company and find out from them.. they should be able to give you a good estimate. either way GOOD LUCK and i'm excited for you... : )

[Bella Luna 1]

Congratulations on your approval!!! I also have Federal BlueCross BlueSheild-Basic. Everything will be submitted to insurance next week for approval. I'm very nervous. How long did it take for you to get your response?

Did you have to submit a 5 year weight history? I do and that is what's making me most nervous! I have one weight a year for the past five years either from my Dr., Jenny Craig or Weight Watchers. I'm not sure if I should sumbit additional weights showing that I have been able to loose weight in the past, or if I should only show them the high weight for each year. Any suggestions? One time on Jenny Craig I lost enough weight that my BMI was below 35. All the other years, except for this year my BMI was between 35-39. I can't decide if they want to see that I've been fat for the past five years or if they want to see that I've been able to loose weight, but just not keep it off. I also have high cholesterol so hopefully that should help with the approval. (I've never taken medication for it). Thanks for any insight you can provide.

As to your question. I don't know the exact answer, but I think I read somewhere that someone else with Fed BCBS researched and determined your surgery cost depends on whether you're inpatient or outpatient. I think they said that if you're outpatient you still have the $100 copay per physician, plus I think $100 to the hospital and then about 30% or somthing of the devise, which could end up costing about $3,000-$4,000. But if you stay overnight then their is no charge for the device, only the couple hundred dollars co-pay for the surgeons. You should call the insurance to double check. I hope this helps! Do you have a date set yet?

[Alisomniac 0]

My surgeon's office submitted 8/17 and 8/26 I got the call I was approved... So 9 days assuming they called immediately... and I know they wait for a written confirmation - probably faxed. I was shocked how fast it was!

As for the medical history, I had fluctuated greatly too... I showed just weight/diet history - ups and downs. i didn't do formal Jenny Craig/WW but I did have years worth of bank statements showing gym membership, Amazon.com order history for various weight-loss products, videos etc...

I'm hoping i dont have to pay 30%! I re-read the brief insurance coverages and it just said 100 per surgeon, but then also said "preferred provider/non-preferred pay all expenses", so it was vague, will have to call ASAP monday...

Hoping someone with my exact insurance will come by and clarify!

[Angera 2]

I have BCBS in Texas. I had to pay 20% plus copay and hospital deductible. Mine required that i pay that 20% the day of my surgery..............so i had to prepay and anything not covered would get billed to me.

day of surgery it was about $1500.

[mom05 0]

I would call your insurance.. ask questions and don't be embarrassed two ask the same question again and again.. I was the same way I needed to know exactly what I was going to end up paying. I have PPO Anthem Blue Cross, me I had to meet my deductable which I meet and my out of pocket expense for the year, but you have HMO and they are different since you don't have a deductable or an out of pocket expense.

But like I said call them and make sure you are clear and satisfied... It's ok to tell them this is what I understood from you is this correct?

Good Luck..

Edited August 30, 2010 by mom05

[Kristy29 0]

I have a PPO through Aetna. We called the insurance company ahead of time to find out, and it's really the only way to know. I had to pay 10% of the total cost, but we have a yearly cap of $1000, and since I had already paid some of that in co-pays and for some overage on testing, the max I will have to pay is $620.

[Overweight 0]

You will likely have just your co-pay but you should call your insurance company just to make sure. Other out of pocket expenses would be for things like a Complication Insurance policy or other insurance that is purely optional. Congrats on getting your surgery approved. It shouldn't cost you an arm and a leg since insurance will cover the majority.

[Alisomniac 0]

Just called BCBS (reminder: I have FEB BCBS of So.Cal HMO) and they said inpatient the cost on my plan would be $100/day, outpatient is $250 per surgery... So barring any unpleasant surprises or misinformation it should be $250 - big relief. i'm planning on double-checking this info with my surgeon's group and calling again (can't be too careful) but so glad i dont have to materialize $2000 out of the blue.

[Bella Luna 1]

"As for the medical history, I had fluctuated greatly too... I showed just weight/diet history - ups and downs. i didn't do formal Jenny Craig/WW but I did have years worth of bank statements showing gym membership, Amazon.com order history for various weight-loss products, videos etc..."

That's Great News!!!

When your weight fluctuated, did it fall below a BMI of 35? I had Jenny Craig right my beginning and ending weight for the two times I did Jenny Craig (in 2006 and 2007). So my beginning weight in 2006 my BMI is fine, but my ending weight is throws my BMI to under 35. Do you think this should be a problem? Just in case I am having them send a new letter which shows only my beginning weights. Any thoughts?

[Alisomniac 0]

Yup. My lowest BMI from weight loss attempts that I reported was 32... I didn't list the specific BMIs, only weights and dates I recorded the weights (which was easy to find out ONLY because I use FitDay to record calories and weight - since 2004).

They want to see that it is really hard for you to loose weight and keep it off.

Shouldn't be a problem, but look for other weights and dates, if you have them... I just listed them all on paper, and only had a couple of screen caps for like 2-3 of the weights. Most of my evidence was in purchases, gym memberships, photos of all the dvds, books, magazines, etc... from over the years... i included date purchased/published so these had more "weight" as evidence. Showed an intent for several years.