Anthem BCBS Ohio

[HollyJ2621 19]

Hi guys! I have elected to have gastric bypass surgery and it is covered by my insurance. I currently live in Florida but my company's corporate office is in Ohio so I'm covered under anthem OH. My insurance requires 3 month nutritional, PCP referral, psych evaluation, I'm currently in my second month of the nutritional requirement and have my psych eval next week... As I'm half way to submitting to my insurance for approval I nervous as to what I will have to pay out of pocket. I feel like I'm so close to the finish line and I'm afraid financially is where I'm going to stumble... My question is to anyone who has the same insurance what did you end up paying out of pocket? And what issue did you have getting approved? Thanks!

[Roo101769 742]

I am covered by Anthem BCBS in Ohio. I had a vertical sleeve gastrectomy in October, and it was covered virtually 100%. Every policy is different and has different requirements as placed by your employer. (I did not have to do months of counceling or diet) The hospital contacted me weeks before surgery to tell me my costs. At that time my old insurance had not transfered our records to BCBS. (We switched insurance in June and any costs we paid until then were being applied to new insurance) Basically you are responsible for whatever amount you have open to your annual out of pocket max. The hospital said I would owe $1800 because, at that time, that was the difference between what I had paid and what my out of pocket max was. But....in my case I had already had extensive hospital costs earlier last year for DVT/PE. Once those costs were applied to my new insurance I ended up owing nothing for the surgery! So...you should find out from the hospital sometime soon. They are willing to discuss payment arrangements so don't give up hope!

[HollyJ2621 19]

Thank you so much! I talked to my surgeons office yesterday and to them alone after I meet my deductible I will owe $1300. My out of pocket max is $10000 so he said we would contact the hospital and see how much theyre fee would be. I guess I'm a little confused as to what the out of pocket max is?