Bcbs Il Bmi 37.5 + 3 Comorbids

[Lori Voss Green 93]

FallonB....out of pocket means the most you pay yourself. Sometimes deductible is included in that amount, sometimes the two are separate. If you are using providers who are in network, they are required per their contract to accept whatever BCBS figures to be the allowed amount. Anything they bill over that they have to take as a write off. For example, if they billed 70,000 but BCBS allowed 10,000.....they would have to write off the difference. Then, if your deductible is met, you will owe a % of the 10,000 until you reach the out of pocket maximum. So, if you have an 80/20 policy, once your Deductible is met, BCBS pays 80% of the allowed amount (the 10,000 in the example here) and you pay 20%. That 20% you are paying is what goes to the out of pocket maximum. So the MOST you would pay out of pocket would be your deductible then whatever the out of pocket maximum is.

Take my policy for example. I had a 600.00 deductible. After deductible was met, BCBS paid 80% of the allowed amount, I paid 20%. My 20% went toward my out of pocket maximum of 1200.00. Once my 20% added up to 1200.00 (because my deductible didn't apply to my out of pocket maximum), they services for the rest of the year are covered 100% of the allowed amount by BCBS as long as the providers are in network & the services is a benefit of my contract. I had surgery (not lap band, different) in January. My deductible and out of pocket maximum was met with that....so I had 1800.00 in bills that were my responsibility. However, after that BCBS has paid 100% of the allowed amount for my claims. So when I had surgery (lap band) in August, I had no patient share because my deductible and out of pocket maximum were met in January.

Hope that helped!

[Lori Voss Green 93]

OMG...please ignore all of the typos and grammatical errors in my last post. That was........bad.

[FallonB 102]

Thank you so much! And I figured it out - She told me 15,000 because it's 5 per person and we have 3 on our plan. That's why I questioned it. Either way, when I was younger, I never imagined that these would be the things I'd get reeeeally excited about at 23. I don't care if there's only a few months of the year left, my lapband is getting paid for by insurance 100%! Woop Woop!

Sent from my Galaxy Nexus using LapBandTalk

[FallonB 102]

Oh, and a lady by the name of Tammy probably thinks I'm crazy when I told her I loved her. LOL. (lady that works at BCBS IL)

Sent from my Galaxy Nexus using LapBandTalk

[Lori Voss Green 93]

Hahaha trust me, I know how you feel. Not having to pay anything was a huge part of why I finally got my surgery! Also, I bet you made that Customer Advocate's day! I can't tell you how very rude and mean a lot of people can be and are when they call and speak to us. No words can describe how nice it is when you can not only tell someone something good, but also when you know you are making a difference in someone's life.

[FallonB 102]

Well, I was very nice, but I may of yelled in her ear a bit! Haha. Oops. =P

Sent from my Galaxy Nexus using LapBandTalk

[pink dahlia 2,513]

yay for you !!!!!! congrats !!! I have BCBS too, i had a bmi of 40, with 2 co -morbities (high BP and sleep apnea.. ) they approved me last Nov, , paid 100 %, so i was banded Dec 13th, 2011 weighing 225 lbs, wearing a size 18. tired all the time, hated the way i looked etc. Im down to 169 lbs (this am i hit 169.5 !!! Me !!!! i havent been 169 in 20 years !!!! ) I wear a size 14 , no more high BP or sleep apnea , and love the way i look. I hope your journey is as easy as mine has been. Good luck !!!

[Michele S 0]

This gives me hope, seeing the dr for the first time Friday and I have Horizon BCBS (NJ) BMI of 53 so keeping fingers crossed.

[lilmickey78 52]

I am new here (1st post) and will be going in for my 6th month appt next week, only to find out that bcbs took that requirement away? I did lose about 18lbs so I guess thats a good thing? I have *** so I need a referral to a bariatric surgeon from my PCP. I've seen a nutritionist already, in my 1-2 months. Is there anyone that might know the timeframe in which I can get in? My insurance will most likely change by November, so I was hoping to get everything done by then...Please

Advise!

[lilmickey78 52]

Sorry, I have an (***)

[lilmickey78 52]

Sorry' date=' I have an *** with BCBS[/quote']

H m o

[FallonB 102]

@Michele, any updates?!

@lilmickey, no one can say for sure for you. What is your BMI? In my experience and what I've heard, you shouldn't have a problem if you have a BMI of at least 35 with comorbids or 40 with no comorbids needed and your doctor/hospital is in network. The quickness will rely on your doctor's office. I'd talk to them about it and see if they can speed it up.

[FallonB 102]

The H m o think made me LOL, by the way. Haha.

[FallonB 102]

The H m o thing made me LOL, by the way. Haha.

[FallonB 102]

The H m o thing made me LOL, by the way. Haha.