quefine 2 Posted June 22, 2012 HI MY BENEFITS START 8/1/12, I WILL BE COVERED BY BCBS ANTHEM THROUGH MY EMPLOYER...IT HAS A $2000 ANNUAL DEDUCTIBLE AT 80/20 AND A TOTAL OUT OF POCKET DEDUCTIBLE OF $4000 AT 100%....I HAVE ALREADY WENT TO A SEMINAR..I SCHEDULED MY PRIMARY DOC VISIT FOR 8/2/12 IN THE A.M. AND MY INITIAL BARIATRIC CONSULTATION FOR 8/2/12 IN THE P.M...AT THE SEMINAR I SPOKE WITH THE FINANCIAL LIAISON THAT WORKS FOR THE DOCTORS OFFICE....AND SHE WAS EXCITED ABOUT MY INSURANCE PROVIDER...SHE WAS EXTREMELY CONFIDENT IN REASSURING ME THAT AS LONG AS I MEET THE REQUIREMENTS FOR THE SURGERY(IM 33 YEARS OLD/5'8/480 LBS/BMI 72.98/SLEEP APNEA) THINGS WILL GO SMOOTHLY AND QUICKLY...I ALREADY KNOW THAT AFTER MY ANNUAL DEDUCTIBLE OF $2000 IS MET THAT THERE IS A MONETARY OUT OF POCKET PAYMENT THAT I WILL HAVE TO MAKE....AND THATS WHAT IM INQUIRING ABOUT TODAY....IS OR HAS ANYONE HAD THE Roux En Y PROCEEDURE DONE AND BEEN COVERED UNDER THIS INSURANCE...IF SO I WOULD LIKE TO KNOW HOW THE APPROVAL PROCESS WENT...IF NOT TOO MUCH INFO, THE TOTAL AOUT OF POCKET PAYMENT THAT HAD TO BE MADE PRIOR TO GETTING THE SURGERY!!!! I WOULD GREATLY APPRECIATE ANY INFORMATION I CAN GET SO I CAN START PREPARING FOR A SMOOTH STRESS FREE PROCESS!!!! THANK YOU!!! Share this post Link to post Share on other sites
BBdoodle 483 Posted June 22, 2012 Hi - I have Horizon BCBS / PPO plan and did not have any problems what so ever getting approval. My BMI was 36 which was under the 40 required but I also had high B/P which allowed me to have the surgery. The only out of pocket expense was a $250.00 co/payment for the 3 day hospital stay. Share this post Link to post Share on other sites
Jen in SoCal 189 Posted June 22, 2012 I have anthem bc/bs and I was approved in less than two weeks. As a matter of fact I had my surgery after just one month of my first doctors appt. The surgical center I went to had me fill out a lot of stuff online and I was fortunate enough to be able to take my psych evaluation over the phone as the psychologist said I didn't "raise any red flags". All of this happened before I actually stepped foot into their office. I had to cram a lot of appts into a short period of time, sometimes two or three a day but that was really convenient for me and my work schedule. My BMI was 40.1 and I didn't really have any complications due to my weight except for arthritis. my total out of pocket was about 3000. But that was my fault for picking the least expensive coverage option at open enrollment last October. Totally time was about 6 weeks after my first inquiry online. It all happened so fast sometimes I wake up in the morning and have to feel myself to make sure it wasn't all a dream. I hope everything goes smoothly for you as well. Share this post Link to post Share on other sites
babygirl901 173 Posted June 25, 2012 HI MY BENEFITS START 8/1/12' date=' I WILL BE COVERED BY BCBS ANTHEM THROUGH MY EMPLOYER...IT HAS A 2000 ANNUAL DEDUCTIBLE AT 80/20 AND A TOTAL OUT OF POCKET DEDUCTIBLE OF 4000 AT 100%....I HAVE ALREADY WENT TO A SEMINAR..I SCHEDULED MY PRIMARY DOC VISIT FOR 8/2/12 IN THE A.M. AND MY INITIAL BARIATRIC CONSULTATION FOR 8/2/12 IN THE P.M...AT THE SEMINAR I SPOKE WITH THE FINANCIAL LIAISON THAT WORKS FOR THE DOCTORS OFFICE....AND SHE WAS EXCITED ABOUT MY INSURANCE PROVIDER...SHE WAS EXTREMELY CONFIDENT IN REASSURING ME THAT AS LONG AS I MEET THE REQUIREMENTS FOR THE SURGERY(IM 33 YEARS OLD/5'8/480 LBS/BMI 72.98/SLEEP APNEA) THINGS WILL GO SMOOTHLY AND QUICKLY...I ALREADY KNOW THAT AFTER MY ANNUAL DEDUCTIBLE OF 2000 IS MET THAT THERE IS A MONETARY OUT OF POCKET PAYMENT THAT I WILL HAVE TO MAKE....AND THATS WHAT IM INQUIRING ABOUT TODAY....IS OR HAS ANYONE HAD THE Roux En Y PROCEEDURE DONE AND BEEN COVERED UNDER THIS INSURANCE...IF SO I WOULD LIKE TO KNOW HOW THE APPROVAL PROCESS WENT...IF NOT TOO MUCH INFO, THE TOTAL AOUT OF POCKET PAYMENT THAT HAD TO BE MADE PRIOR TO GETTING THE SURGERY!!!! I WOULD GREATLY APPRECIATE ANY INFORMATION I CAN GET SO I CAN START PREPARING FOR A SMOOTH STRESS FREE PROCESS!!!! THANK YOU!!![/quote'] I have BCBS of TN FEDERAL EMPLOYEE PLAN. I've only paid a $300 copay so far. Share this post Link to post Share on other sites