90 day insurance wait for a fill?

[sherilynn 1]

I called my surgeon today to schedule my 6 week post op fill. I was told that I have a 90 day waiting period on my insurance plan; Horizon BC/BS NJ. I was sooooooo upset since I don't have too much restriction, and I'm sure by 3 months post op - I'll have regular eating capabilities. So I called my insurance, and they told me absolutely not - I can get a fill anytime I wanted. A fill would cost me about $1000k if I self pay. I called back the doctors office and left a message about me calling insurance on my own...I'm waiting for them to get back to me. But they told me many insurances have a 90 day recovery period before any fill will be paid for. You ever hear of this???

[piercedqt78 658]

I got a fill 7 weeks post-op, no problems. My ins paid 100%. ~Mandy

[Ariel 1]

A fill would cost me about $1000k if I self pay.

Why would a fill cost do much? Do you mean one hundred dollars.

[sherilynn 1]

Nope, about One THOUSAND dollars - Doctor fee w/o insurance is $440 and the hospital is about the same price (he does fills with fluro at the hosptial).

Shoot, for $100 bucks, I'd be getting a fill every month! The way I see it, to pay out of pocket for my FIRST fill - may not even be worth it, since from what I'm hearing the first fill isn't always providing good restriction.

Again, tonight - I feell like I ate like a monster! 3 slices of Hormel turkey and a very small red potatoe. NOTHING compared to what I've eaten in the past - but certainly not the 1/2 cup recommendation either.

[Leecelove70 0]

Nope, about One THOUSAND dollars - Doctor fee w/o insurance is $440 and the hospital is about the same price (he does fills with fluro at the hosptial).

Shoot, for $100 bucks, I'd be getting a fill every month! The way I see it, to pay out of pocket for my FIRST fill - may not even be worth it, since from what I'm hearing the first fill isn't always providing good restriction.

Again, tonight - I feell like I ate like a monster! 3 slices of Hormel turkey and a very small red potatoe. NOTHING compared to what I've eaten in the past - but certainly not the 1/2 cup recommendation either.

Thats so stange I have Empire Bc/Bs PPO of New York and my first three months were covered for everything even my first fill! My Nurse NP(surgical assistant who does the fills)did not feel I needed a fill with in the three month time frame since I had lost 40 pounds. I had my and one any only fill on Ocotber 25,2006 of 1cc which I did not pay for, just paid for the office visit.

My monthly follow ups are with my Nurse Np and dietican and they are not covered by insurance, they each charge $80.00 each which is out of pocket. I am able to get remburished for my out of network fees up to a certain amount. I have to sumbit recipiets each month.

I have lost 57 pounds since my surgery on June 13th and Iam 8 1/2 months out!

Most fills after the first three months are usually not covered by insurance,I would call your insurance ask for Medical Management department and ask alot of questions on how Lapband bariatric surgery is handled.

I had to do this with Empire when getting my approval for surgery they were both informative and very nice.

Good Luck -- Hang in there the journey is so worth it!

Lisa

[Candle 11]

I haven't been banded yet but my doctor's fee for surgery includes the first 3 months of after-care and fills. I thought most did the same - free for 3-12 months.

After that, I will have to self pay for my fills and doctor visits ... $75.00. My doctor doesn't do fills with fluro regularly but if they need to, I think they said the fee was $225.00

I live in Long Island, NY ... I thought THIS was the most expensive place on earth - lol. You are in NJ? In all my research I have never seen anyone say their fills were $1,000.00!!!!

[*JASMINE* 1]

Hi Sherilynn,

Most surgeries have what insurance carriers call a 10 to 90 day "global period". This means that for this time after the surgery, they will not pay for any post op visits. This should not mean that the surgeon should deny care for this amount of time. Choosing not to see a patient during this time is a doctor's choice, but not the most ethical decision.

For example, a wound repair usually has a 10 day global period. Most doctors would still choose to see this patient in follow up before this period is up because that wound still has to be cleaned and dressed properly by a medical specialist. The doctor still has to make sure that no problems arise from this wound, such as infection.

This office's choice not to see you for 3 months, in my opinion, is unreasonable. It is a choice made not for a patient's well being, but to make sure that they can get around this global period. By the way, most surgery fees are adjusted to include services rendered during the global period.

Dr. C hangs out in the complications section. You might want to ask him why a doctor would choose to go this route. Hope this helps.

[piercedqt78 658]

I haven't been banded yet but my doctor's fee for surgery includes the first 3 months of after-care and fills. I thought most did the same - free for 3-12 months.

After that, I will have to self pay for my fills and doctor visits ... $75.00. My doctor doesn't do fills with fluro regularly but if they need to, I think they said the fee was $225.00

I live in Long Island, NY ... I thought THIS was the most expensive place on earth - lol. You are in NJ? In all my research I have never seen anyone say their fills were $1,000.00!!!!

My surgeon didn't include anything other than the follow-up visit 1 week post-op. My fills we up to me with the original surgeon, they refused to even try to bill my insurance. I have switched surgeons and they bill the ins $1600 with flouro, the ins pays $800. Part to the hospital and part to the surgeon. But I have to pay nothing, both are in network. ~Mandy

[Candle 11]

Wow! $1600!

It's really amazing how everyone's experience is so different! Seems like every doctor does something different.

[piercedqt78 658]

The hospital does the billing, and that covers the fluro, the surgeon and the hospital fees. My surgery was billed at $33,000. No where near that was paid but that is what they bill. The cash price was half that. ~Mandy

[sherilynn 1]

I put another call into my surgeon again today. I told them that my insurance does NOT have a 'global' period. The doctor WILL see me for my 6 week follow up; but was told I won't get a fill at that time. What really sucks is having to take the time off from work for separate visits like this. I'd like my 6 we f/u appointment to coincide w/my 1st fill. But, I knew I'd need time off for things this year - so I've alloted the vacation time. I'll see what happens when I get my 'call back'...maybe another 3 days....

Funny, to collect money how fast they are to get back to me. hehehe