FEP Blue basic costs

[chinamama 104]

Some have asked about out of pocket costs. I'm 2 mos out and I think everything is in. 3 nights in hospital, and surgery. Pre op testing, I think my out if pocket is right around $850. Seems lower than I thought it would be, hopefully nothing else pops up.

[Lulu5 24]

How much was your surgery (hospital copay and surgeon copay)? Did you have to pay 30% of your drug costs for the anesthesia used during your surgery?

Sorry for so many questions. I just don't want to be blind-sided by FEP blue. Thanks!

[chinamama 104]

Your questions are why I'm worried not everything is in. When I was banded almost 6 years ago I got those extra charges. This time it pretty much seems like just the daily and surgery copays. I'll try and find my eob and let you know.

[chinamama 104]

Ok can't find the dr, but I think it was like 7800 for the dr and the same for the PA. I think my copay was $150

Psy charge $672/ paid 407. copay $25.00

Hospital: surgery, drugs, pathology, X-ray ( must be the leak test) etc $28,893.43 bc paid 16,350. Copay $450.

Pathology (stomach) $402. Bc paid $402 my part $0

sleep dr paid 0 copay. ( that may have been for the overnight o2, didn't need a sleep study) thought I paid a copay for the dr appt. hubby's overnight sleep study was $100.00

Can't find the eob for my EGD

Hope this helps. Sooo about 50,000+ for everything I paid about 800 give or take.

[Lulu5 24]

Thanks for the info. I'm asking because a while back, I had a laproscopic outpatient surgery and the insurance company only paid 30% of the anesthesia drug charges, leaving me with a bill of $700 to pay for my anesthesia! I've been battleing with bcbs for months now because they told me 3x before my surgery (and many, many times after the surgery) that anesthesia is covered 100% under my plan. I just don't want any surprises. I will talk to bcbs prior to my sleeve surgery and get it in writing that they will cover my anesthesia 100%.

[chinamama 104]

Weird... Are you basic? I couldn't find an eob for anesthesia, I seem to remember seeing it. Was the other surgery in 2012 or 13?

[Lulu5 24]

I have basic. And the surgery was this year (2013). I am thinking since it was outpatient, that I had to pay the 30% of drug charges. BUT, the wording in the benefit plan is ambiguous because one section says anesthetics (drugs) and anesthesia services are 100% reimbursable. But then another area says that I am responsible for 30%. The actual anesthesia services (the anesthesiologist) was covered 100%. I'm still fighting it and trying to get it worked out.

[band2sleeve2014 15]

ChinaMama,

Is FEP Blue Basic the same as the Federal BCBS Basic? If so, what did you need to do to get approved for the band to sleeve revision? I am looking for the same thing now but based on the details of the policy as I read them it doesn't sound like something they would consider. Any advise would be greatly appreciated!

[chinamama 104]

Yes they are the same. Do you have complications with your band?

I had to do 3 mos diet w/surgeon

3 nut visits

EGD

PCP letter

Psy visit

Removal approved, but revision denied but overturned on peer to peer appeal. They wanted additional documentation.

Good luck

[Lulu5 24]

China mama, have you recieved any other bills? My surgery is next week and the hospital has already asked me to pay my co-pays up front ($150 for the surgeon, $100 for the hospital) but I haven't heard anything about being responsible for 30% of the drugs used during my surgery. I know a few months ago you said you had not received a bill for anesthesia drugs, is that still the case?

Thank you!

[band2RNY 12]

I talked with the insurance lady with my doctors office yesterday. She said that if there are complications with the band, that there are ways to get out of the 3 month diet, etc. But, I don't really know the full details of how to go about getting around it. I'm sure I will find out more on the 27th when I go and see them. She did say something along the lines about the band failing... (slippage, errosion, frequent vomiting, etc) would be reason for this.

I think the charges really all depends on the hospitals and if all services are provided by the hospital. In 2010 for lap band with feb blue basic I only paid 100 copay for hospital and 100 copay for surgery. That was it! All services provided including anesthesia were provided by the hospital and not an outside source. I'm not for sure that is how they get you. But, i'm pretty sure that is how some people walk away with bills higher than the co-pays. You might want to check into make sure the doctor and hospital are part of the in-network providers with fep blue. That might have made a difference as well.

I think this time around my doctor and hospital and the insurance coverage will be different and i'm trying to get all my ducks in a row before surgery is even set and have some sort of idea what my out of pocket will be.

I'll keep y'all posted on what I learn and find out.

[Lulu5 24]

TheMoment: Yes, keep us posted. I spoke with my hospital today too and BCBS and BCBS says my copay for the hospital is $150/day and $150 to the surgeon and I "may" be responsible for 30% of the drugs/agents used during my stay, but it all depends on how the hospital files the claim. When I spoke to the financial advisor at the hospital, she said she would research this and get back with me. I do know that all services I will recieve are from a preferred provider at a BCBS Excellence Center. I just don't want any unexpected bills in a couple of months!

[band2RNY 12]

TheMoment: Yes, keep us posted. I spoke with my hospital today too and BCBS and BCBS says my copay for the hospital is $150/day and $150 to the surgeon and I "may" be responsible for 30% of the drugs/agents used during my stay, but it all depends on how the hospital files the claim. When I spoke to the financial advisor at the hospital, she said she would research this and get back with me. I do know that all services I will recieve are from a preferred provider at a BCBS Excellence Center. I just don't want any unexpected bills in a couple of months!

Yeah, they should be able to tell you everything BEFORE surgery. There should be no "may". The hospital I used last time sent me a bill for some stuff way after surgery and I called them and said no I was told everything was covered. And, they wrote the rest of the bill off. I'll keep you posted.

[chinamama 104]

Still haven't received any other bills. Good luck!

[band2RNY 12]

Surgery is scheduled for Nov 5th! Insurance girl at my doctors office said 150 copays and 30% drugs... but, when the hospital calls me i'll find out if it's all in-network. So, I might not have to pay the 30% drug cost. It all depends on the hospital........ either way i'm just happy i'm getting the surgery and cost isn't really too too important.