Out of network surgeon BCBS?

[Lins 1]

I am just starting the process of looking into lap band. I previously contacted BCBS who told me that I would be covered but I had to have a current bmi over 40 (which I have) and prove through medical records that my bmi has been at 40 over the last 5 years. After that my deductible would be $2,000.

Well I went to a seminar at a center yesterday, and the patient coordinator who checked our coverage during the presentation said that the only requirement I had was my current bmi being over 40, and if I used their out of network surgeon I wouldn't have a copayment just a small fee for the anestethia. Does someone have any insight into why this is the case? I have another appt this week so I plan on looking into more for sure.

I think it has something to do with the fact that the other 2 surgeons and the center itself is in network, but the surgeon who would be doing my surgery comes down from LA (I live in Vegas) is out of network? I would be estatic if this is the case and I have hardly any out of pocket cost, but I'm a little skeptical. I don't want to have the procedure done and end up with a 20,000 dollar bill. On the other hand I don't think this center would move ahead and perform the surgery without knowing exactly how they are getting paid. Like I said I am going to find out for sure but just was wondering if anyone had some advice. Thanks!

[MelindaH 3]

I am just starting the process of looking into lap band. I previously contacted BCBS who told me that I would be covered but I had to have a current bmi over 40 (which I have) and prove through medical records that my bmi has been at 40 over the last 5 years. After that my deductible would be $2,000.

Well I went to a seminar at a center yesterday, and the patient coordinator who checked our coverage during the presentation said that the only requirement I had was my current bmi being over 40, and if I used their out of network surgeon I wouldn't have a copayment just a small fee for the anestethia. Does someone have any insight into why this is the case? I have another appt this week so I plan on looking into more for sure.

I think it has something to do with the fact that the other 2 surgeons and the center itself is in network, but the surgeon who would be doing my surgery comes down from LA (I live in Vegas) is out of network? I would be estatic if this is the case and I have hardly any out of pocket cost, but I'm a little skeptical. I don't want to have the procedure done and end up with a 20,000 dollar bill. On the other hand I don't think this center would move ahead and perform the surgery without knowing exactly how they are getting paid. Like I said I am going to find out for sure but just was wondering if anyone had some advice. Thanks!

Hi, welcome to the forum. I would urge you to call bcbs yourself and see. I would not take the insurance co-ordinator's word on your insurance. They deal with

a lot of insurances day in and day out and you can get benefit structures easily mixed up. I used to verify insurance for a living. Also talk to their business office

yourself.

I wish you all the best in your journey to good health. Please keep us posted on your progress.

Melinda

[Lisa75 3]

yes call bcbs yourself, as i did. the place i am having my surgery had things all messed up. but finally calling myself i got everything taken care of. it's always better to ask your insurance yourself (lesson's i've learned ) best of luck to you

[farmer2120000 1]

1st thing 1st are you basic or standard ? and are you fed bcbs.....

call bcbs and ask rep to confrim info with care mgmt....care mgmt deals with the clams the reps read the benfits brochure like we do and and its not 5 yrs it 2yrs and it doesnt have to be contious 2yrs just got banded yeasterday i have feb bcbs basic.

I am just starting the process of looking into lap band. I previously contacted BCBS who told me that I would be covered but I had to have a current bmi over 40 (which I have) and prove through medical records that my bmi has been at 40 over the last 5 years. After that my deductible would be $2,000.

Well I went to a seminar at a center yesterday, and the patient coordinator who checked our coverage during the presentation said that the only requirement I had was my current bmi being over 40, and if I used their out of network surgeon I wouldn't have a copayment just a small fee for the anestethia. Does someone have any insight into why this is the case? I have another appt this week so I plan on looking into more for sure.

I think it has something to do with the fact that the other 2 surgeons and the center itself is in network, but the surgeon who would be doing my surgery comes down from LA (I live in Vegas) is out of network? I would be estatic if this is the case and I have hardly any out of pocket cost, but I'm a little skeptical. I don't want to have the procedure done and end up with a 20,000 dollar bill. On the other hand I don't think this center would move ahead and perform the surgery without knowing exactly how they are getting paid. Like I said I am going to find out for sure but just was wondering if anyone had some advice. Thanks!

[NYMoMof3 0]

I have BCBS also, but my deductible wa $550, I guess your employers plan determines how much you pay. I used an out of network Dr, and he made me see around 10 specialits to get a full work up to find my co morbidities, because BCBS would do the surgery with a BMI of 30 if it was medically necessary. Mine was a 36 with comorbidities such as high cholestorol, high blood pressure, sleep apnea, diabetes, arthritis in feet, heart disease in your family. They didnt ask me to prove anything about past weights or diet attempts. I heard if you have a bmi of 35 and sleep apnea your almost guaranteed to get approved. Find a Dr and anesthiologist who are either in network or who will take what ever BCBS pays out of network.