anthem bluecross hra/fsa

[stuffystephie 1]

Anyone have any recent experience with a lapband surgery ubder anthem bluecross in ca with an hra/fsa ppo. Ins covers at 80% once deductible is met...and i have to go through the center for medical excellence??

We r switching to anthem effective jan and i want to start the process asap.

[Marybell 22]

i have anthem bcbs of ga... we used up our fsa by mid year ( yah didnt except so much sickies woops ) but i picked a surgeon i wanted. his program fee was 200. i paid the hospital 100 down and im getting billed the rest. a grand total of $3606.88....thats including my 400 dollar deductible. my process started october 10th....surgery was Dec 7th. hope this helped...

[stuffystephie 1]

Was everything done within network and did u have an hra as weell?

[PhatKat1127 55]

I had surgery on Dec 7th 2012 and learned anthem works fast! Granted you have met all of the qualifications. I however learned not only must you meet the deductible, you have to meet the Out of pocket expense max in network as well. Which is in my case $4000.00 for the 80% to kick in. I did thank God! Since I needed to have my gallbladder removed prior to lapband surgery. I paid day of surgery $205.00 and the hospital submitted a claim for 34k which is still pending so I have no clue what my out of pocket will be for the hospital. My lapband was also robotical and was at a max price of 10k which was the going price at my surgeon's office and was also enter of excellence required.

[stuffystephie 1]

Ooh ooh ok so...i have a couple questions lol...forgive for sounding dumb here if i do...now by qualifications u mean requirements to get the surgery?? And the deductible would end up being met with the cost of the surgery correct?? We have an hra with our policy so its used to offset the deductible and we have an out of pocket max of 8k which when met we are covered at 100%...so once all i said and done and they determine i would have to pay 8k or more it would be fully covered right...or do i have to pay that?? I elected for an FSA as well of 1500.00 its not a lot but we are only allowed a max of 2000.00 for our FSA...

I tried calling anthem but they wont discuss it with me because we arent active in their network til jan but i wanna start getting my ducks in a row now...this may put me in a huge debt but it will also help to save my life so i would rather be in debt than dead :-/

[PhatKat1127 55]

So I had tons of questions and called like once a week. I started my venture on Oct. 5th 2012 and was approved by Nov. 13th. I had no co morbidities but anthem stated 35 BMI with at least 2 co morbidities or _40 BMI with NO co morbidities. I was right at 40bmi. I hadn't met my deductible so all my office visits were about $ 90 most costly was the psych visit and the nutritionist which were not covered by my ins. My Hra applied $1000 towards my deductible and exhausted my Hsa. But once I was told I needed to have my gallbladder removed out patient, that procedure made me hit

out of pocket 4k max and my 2k deductible. Since my charges are still pending I'm not sure what was covered at 100%. I'll let you know how it turns out.