BCBS Federal in Texas (Basic or Standard better?) Lap Band to Sleeve Revision

[band2RNY 12]

Ok,

Which is better on coverage? Basic or Standard? I have basic right now. When I had my band in Jan 2010, basic was the way to go. I only paid 100 co-pay surgeon and 100 co-pay to the hospital...very easy process and approval. I wasn't even required to do the psych eval or 6 month diet plan.. I was approved and had the surgery in two weeks after approval. I saw the doctor initially a month before surgery.

Right now, I may be able to get my band removed and possibly get a revision surgery done to the sleeve... due to slippage and doctor not being able to access the port.

Are the lap band to sleeve insurance requirements the same and pretty easy? I just don't want to have to go through all the hoopla with the diet for 3 or 6 months and the psyhc eval. I want it done ASAP if i'm having complications.

From my experience in the past before my lap band, a lot of weight loss "clinics" I called inquiring about the insurance and the surgery..and they all still required the pre stuff, even though a studied my insurance and knew that I didn't. I tried to tell them, that I had federal insurance and not regular blue cross blue shield insurance and it wasn't required for me to do all the pre surgery stuff to get approved. I finally found a doctor in Dallas that the insurance lady was very hip and knew that I didn't have to go through the requirements and had my surgery fast.

I'm hoping it is the same time around this time.....any input would be greatly appreciated and thanks in advance!

[SuzyB 182]

I think the only way to tell is to look at the actual policy. I have blue cross and have one set of requirements, where others have had other requirements. Will your HR dept let you see them.

As far a preop, a lot of that is for the surgeon to know about you, what may be a problem during surgery. Where you have had bariatric, then some stuff may not be needed now. There are often vague statements in policies that give the option for the surgeon to order what he thinks is needed. Something along the line of Surgeon has determined the patient is a good surgical risk. How the surgeon determines that is up to them.

[band2RNY 12]

I think the only way to tell is to look at the actual policy. I have blue cross and have one set of requirements, where others have had other requirements. Will your HR dept let you see them.

As far a preop, a lot of that is for the surgeon to know about you, what may be a problem during surgery. Where you have had bariatric, then some stuff may not be needed now. There are often vague statements in policies that give the option for the surgeon to order what he thinks is needed. Something along the line of Surgeon has determined the patient is a good surgical risk. How the surgeon determines that is up to them.

awesome thanks!..

yeah, i'm trying to look at the actual policy online now. I'm going to try and push it hard so I can get it done quick. I don't want to wait....

I think with him not being able to access the port to my lap band, he told me that I can either have surgery to go in and replace that or he can see about doing the revision (he has to look at my xrays of the band first)... I'll know more on the 27th.

I'm thinking since I have gained weight.... He can't even access the port.... and lap band slippage...it may make it a lot easier for him to get the approval from the insurance just do the revision. I just hope they don't make me go through all the hoopla. I can't see having all these complications and then having to turn around and do the 3 month doctor supervised diet.

[band2RNY 12]

also..which is the better coverage? Standard or Basic... i'm looking now and it says pre auth is required for basic...but only 150 co-pay per day for hospital and 150 for the surgeon.... last time for my lap band surgery and having basic i know my bill was over 50K and I didn't have to pay anything about 100 co-pay hospital and 100 co-pay surgeon and that was all!

seems like standard u don't pay any co-pays but you get charged a percentage of the total bill?

Still sounds like basic is the way to go!

[VSGKirk 855]

I don't have anything to contribute to the insurance coverage portion of your questions/comments, but just wanted to say hope it all goes well for you and we are all here if you need us!

[band2RNY 12]

Thanks guy..i've checked out your profile.... you have rocked it haven't you? lol

[chinamama 104]

Personally I think basic is the way to go. Total out of pocket was under $1000. for all preop, and 3 nights in the hospital. They are a little more stringent I had to do 3 mos with the surgeon. Don't miss a month or you have to start over. Could of had the removal very easily it was the conversion that they made me jump hoops.

[band2RNY 12]

Personally I think basic is the way to go. Total out of pocket was under $1000. for all preop, and 3 nights in the hospital. They are a little more stringent I had to do 3 mos with the surgeon. Don't miss a month or you have to start over. Could of had the removal very easily it was the conversion that they made me jump hoops.

Thanks.... i'm thinking if the band has "failed" that it will be quicker. At least that is what i'm hoping. You went from the band to the sleeve right?

IF so, can you tell me how differently it feels? Like restriction, appetite, etc.

[chinamama 104]

Sorry missed this. Yes, I got the sleeve. It will be 5 mos on the 29th. I'm a slow loser, (28lbs) but I think that is a couple of reasons. My body was already used to smaller portions, and also the excitement of your first time is not there. BUT I am losing.

How do I describe the difference between the two.... With the band if it was tight I could sometimes use tricks to get the food down into the lower stomach, or slider foods I could just keep eating. Now when I'm full I'm just full. Even with sliders. A couple of months ago I had a piece of cake, with the band it would have just filtered thru and I would/could have eaten the whole piece. With I sleeve I ate 1/4 was stuffed and could not have fit anymore in for hours.

Personally I had complications from the band, but after that no problems. Can eat and drink anything, dumped twice once was my fault. At my sisters and didn't realized they had switched to fresh organic whole raw milk. 4 Protein shakes later my body rebelled!!! Lol! Boy those Protein Shakes were good! The other time was a Frapachino at Disneyland, combined with a new medication and a little dehydration. Not a good combo.

As you can see there is probably a reason why I lose slow, but I refuse to not live. I still track everything even when I indulge. Good luck!

[cricketcree 10]

I am switching to bcbs basic when open season begans for next year. With basic you see your primary physician for 3 months, go to nutrition classes (that's with the standard too). With basic you pay $150 for the surgeon fee, and $100 a night per night in the hospital and 30% of meds and supplies. With standard you pay your deductible ( I think it's 350) plus $250 to the surgeon, then 30% of the hospital stay supplies, and $150 per night. Basic is definitely the way to go. A friend of mine had the sleeve done with basic insurance and only paid a total of like $600 for the entire surgery. Whereas I have a friend that has standard and was out of pocket $2000. But any insurance company you use will make you see your physician for 3 months regarding weight loss, and a psych eval, nutrition classes. That's standard protocol. I will be switching g to bcbs basic in January, ( I've already got all the pre op stuff done) and will ha e my surgery on jan22nd!!

Good luck, hope this helps!!

[1gorgeousgodzilla 192]

I'm BCBS basic and while I've not had the revision, my total hospital bill for the sleeve and 2 nights in the hospital was $300. Just make sure your hospital, surgeon, anesthesiologist (I.e. EVERBODY) is in the network. Best of luck to you! I think basic is the way to go with respect to these types of procedures.

[cricketcree 10]

Wow!! That's great to hear!!! I have GEHA. My surgery date was set for sept 10th. I had to do 6 visits (6 months ) of going to see my family doctor first. The beginning of my surgery the hospital told me that my part was $500 for hosp stay and 350 for the surgeons cost. 2 weeks before surgery I was told it was going to cost me around $2200. I'm a single mom and might can get together $800, but $2200 is a whole different story. And I didn't wanna have to borrow money and get another bill. My surgeons nurse suggested waiting til January and switching to bcbs basic, that I should only be out of pocket $500-$700. So, I'm patiently waiting!

[cricketcree 10]

I meant beginning of my journey to get ready for surgery*

[band2RNY 12]

Sorry missed this. Yes, I got the sleeve. It will be 5 mos on the 29th. I'm a slow loser, (28lbs) but I think that is a couple of reasons. My body was already used to smaller portions, and also the excitement of your first time is not there. BUT I am losing.

How do I describe the difference between the two.... With the band if it was tight I could sometimes use tricks to get the food down into the lower stomach, or slider foods I could just keep eating. Now when I'm full I'm just full. Even with sliders. A couple of months ago I had a piece of cake, with the band it would have just filtered thru and I would/could have eaten the whole piece. With I sleeve I ate 1/4 was stuffed and could not have fit anymore in for hours.

Personally I had complications from the band, but after that no problems. Can eat and drink anything, dumped twice once was my fault. At my sisters and didn't realized they had switched to fresh organic whole raw milk. 4 Protein shakes later my body rebelled!!! Lol! Boy those Protein Shakes were good! The other time was a Frapachino at Disneyland, combined with a new medication and a little dehydration. Not a good combo.

As you can see there is probably a reason why I lose slow, but I refuse to not live. I still track everything even when I indulge. Good luck!

Thanks! This gives me hope. The band just flat out sucks. I don't like the feeling of it at all. You have just taken all of my negatives about the band (word for word) and it sounds like the sleeve corrects it all. I wish I would have done this surgery in the 1st place instead of being at the spot I am right now.

[band2RNY 12]

I am switching to bcbs basic when open season begans for next year. With basic you see your primary physician for 3 months, go to nutrition classes (that's with the standard too). With basic you pay $150 for the surgeon fee, and $100 a night per night in the hospital and 30% of meds and supplies. With standard you pay your deductible ( I think it's 350) plus $250 to the surgeon, then 30% of the hospital stay supplies, and $150 per night. Basic is definitely the way to go. A friend of mine had the sleeve done with basic insurance and only paid a total of like $600 for the entire surgery. Whereas I have a friend that has standard and was out of pocket $2000. But any insurance company you use will make you see your physician for 3 months regarding weight loss, and a psych eval, nutrition classes. That's standard protocol. I will be switching g to bcbs basic in January, ( I've already got all the pre op stuff done) and will ha e my surgery on jan22nd!!

Good luck, hope this helps!!

It helps a lot. Thanks! I have the band in right now and having complications so I might not have to do the 3 month diet, etc. BCBS fed must have changed the 30% drug thing because in 2010 I didn't have to pay anything other than co-pays. I'm not going to complain though as it's still much cheaper than without insurance.