questions

[Guest teeta99]

I have my first visit with Dr. Felix Speigel on Friday. I know that my current insurance covers the lap band surgery, but I was wondering if anyone knows how much money we have to come up with before surgery? When I called the office, they said it depends on your insurance. So I still have no clue. I was also wondering if anyone knows if Blue Cross Blue Shield covers this surgery. Thanks.

[Alexandra 55]

Teeta, it really is true that the answer to this question relies totally on the insurance plan you have. Is it a PPO or an HMO/POS? Do you have an in-network doctor? Do you have a hospital copay? Are you going to an in-network hospital?

There is no way anyone can answer your question without knowing the precise details of your policy. I can tell you that in MY case, with an HMO plan, I paid the office-visit co-pay for each visit to a doctor's office (surgeon, PCP, and dietician), and had to pay in full for the psych evaluation because there were none in my network. That came to about $275. Then for the surgery itself I was charged only an office-visit copay, because I was operated on as an outpatient and didn't have to stay the night in the hospital. If I had stayed overnight, my charge would have been $250.

But NONE of this pertains to you. What kind of plan do you have? If you call the membership services number on your insurance card they can clarify your plan and the way it works. If they say anything that is confusing, ask again. It's their job to help you understand exactly what your responsibilities are.

As for whether BC/BS covers the band, the answer to that is again, it depends. BC/BS is not one company, it differs from state to state. I know that Horizon BCBS in New Jersey does cover the band, and Empire BCBS in New York is coming around. Where are you?

Good luck!

[Guest teeta99]

My husband's insurance is switching to Blue Cross Blus Shield of Texas as of May 1st. I wasn't sure if they covered the surgery.....but I think that they do. Our coverage is 90-10. My friend was just banded 2 weeks ago and had to come up with her entire deductible on the spot for her insurance.....$3500. I do not have the luxury of being able to come up with my entire deductable at once. BCBS can't give us any info because the policy doesn't take effect until May 1st. Just a little frustrated. Thanks for listening.

[angelatn2001 0]

Hey Teeta,

I know for sure that blue cross of TN is covering the band but that other blue cross ins. is not. I think that it is crazy some blue cross covers it and others dont!! My fiance has blue cross of Alabama and they consider it to be experimental still.

As far as paying on my surgery I had to stay overnight in the hospital and was billed for my surgery. I did not have to pay anything up front for that. My doctor visits i just had a copay and then on my fills my doctor now does the first one free and the others are $150. I am now self pay so everything has to be paid up front.

Keep us posted

Angela

[Guest teeta99]

This is considered an outpatient surgery, so if a night stay in the hospital is requird, what happens? Just curious.

[angelatn2001 0]

I really dont know. When i had the surgery it was not considered outpatient.

Angela

[Alexandra 55]

Originally posted by teeta99

This is considered an outpatient surgery, so if a night stay in the hospital is requird, what happens? Just curious.

If you're having outpatient surgery and there's a problem, they'll just admit you to the hospital for an overnight stay. At that point, whatever your specifications are for a hospital stay will kick in. With a 90/10 plan my guess is that you have an in-network deductible, PLUS you'll have to pay 10% of the next $10,000 (an additional $1000). If your in-network deductible is $1000, your out-of-pocket for a hospital stay would be $2000.

Outpatient surgery may be covered as an office visit or it may be subject to deductible and coinsurance. You should probably calculate your maximum out of pocket and be prepared to pay that much if necessary. However, not every surgeon will demand those amounts up front, or even all at once. Many doctors will let you pay off your portion over time.

[Guest teeta99]

Thanks for the help. I fell a bit lost at times because you hear so many different things depending on who you talk to. I really appreciate the help.

[Joyce 0]

Hi Teeta

I am also having the surgery with Dr Spiegal. When I went to reg. at the hospital they told me my total was 2500.00.So I had to cancel because I did not know that.The hospital is going to set payments.I am having it at Mid Jeff.Did your friend go to Dr. Spiegal too? I know that they haven't got any Dr. over there yet to do the surgery.So know my sugery is set for 4-28-04.Isn't Mellissa sweet?

keep in touch

Joyce

jjfredericks4@aol.com

[kellymoos 4]

I was banded by Dr. Speigel in Aug 03 and had to pay $ 2500.00 up front. My sister just had the surgery by him and has BCBS and just had to pay her $ 20.00 deductible for the first office visit. She was very lucky and has wonderful insurance. BTW, I am involved in doing a commercial for him on Thursday. I was on one before...Hope all goes well and good luck:-)

[Guest teeta99]

So the hospital cost is $2500 regardless of insurance? Did BCBS cover it any differently for your sister? Dr. Speigel did do my friend's surgery and she has lost 20 lbs. in 2 weeks.

[Joyce 0]

well the hospital said 500.00 of the 2500.00 was my deductable.But let me tell you about Dr.Spiegel office they really work with you.the hosptial wants me to put a least 1/2 down but Dr.Spiegal office said if I can't right now don't worry about it that they or he will talkl to the hospital. I thank everything will be find for you.They are good people the like to help.

keep in touch

Joyce

jjfredericks4@aol.com

[Guest teeta99]

Okay, thanks for the input. I need all I can get ! !

[kellymoos 4]

My out of pocket for the year was $ 2500.00 with my insurance and that is what I had to pay. My sister did not have to pay anything. She had to do a sleep study, meet with a dietician and then a psych exam before they approved her surgery. But, they did cover the whole thing. Every policy is different. Like Joyce said, maybe you won't have to pay it all up front.