BCBS Co-Insurance for Bariatric Surgery?

[momma_missie 30]

I've asked similar questions before and not got much of a response, so going to try to be a little more clear this time in hopes others have similar experiences and could share their stories.

I have BCBS of Michigan. I am covered under my employer and I have 50% co-insurance coverage. My out of pocket co-insurance maximum should be $3000 according to my plan documents. My out of pocket max for healthcare period should be $6,600, this includes my co-insurance payments according to my plan documents.

I have done my psych eval, surgical consult, etc. and the hospital should be submitting for approval for the procedure this upcoming week. However, the lady who is in charge of getting approval for the surgery made a comment about how co-insurance and out of pocket maximums don't usually apply to bariatric surgery and that I would likely be spending $15,000-$20,0000 out of pocket in order to have the procedure. She couldn't give details because she wasn't from the financial department, but she told me that I'd be in touch with someone from financial to figure out what costs I'd be responsible for once she gets me approved for the surgery.

I was heartbroken and have been in a bad mood ever since. I'm sick with worry, fear, anxiety, etc. I want and need this surgery more than I'd been willing to admit until recently. I was every bit prepared to pay $6000 - $7000 out of pocket. It's a small price to pay. Just wondering if others had co-insurance amounts they had to pay and if bariatrics were included or excluded. Thanks in advance!

[Sharon1964 2,530]

I've never heard of an exception to out of pocket maxes. I think the lady was wrong. Maybe she was thinking of people whose insurance is out of network. My out of network max is double my in-network max.

Call your insurance company and ask them to be sure, but if I were in your shoes, I would not worry.

[BrownEyedTxGirl 139]

I have actually heard of this before, especially in regards to bariatric surgery. I would contact your insurance company directly and ask them to outline your benefits and coverage. I did this with my insurance company and easily had all the info from them within 10 minutes.

I would also contact the insurance company to make sure everything jives with what the doctors office is telling you. Because I had reached out to my insurance company in advance I knew what my pre-requisites were and the doctors office was telling me something completely different. In the end my doctors office was completely wrong! Keep in mind that everyone's insurance is different. Your BCBS coverage will not necessarily be the same as someone else's BCBS coverage as yours is determined by benefits that your company has selected.

Even though I checked out all my coverage with my insurance I pretty much knew from day one that I would pay cash as it would just be easier and quicker! My cash pay in Texas is half of what they are saying your deductible will be!

Give the insurance company a cal in the am to get the facts

[judyoz 240]

I would call BCBS and get it straight from them. Otherwise maybe consider paying cash in Mexico? Lots of people do on here. I had mine in the states.

[momma_missie 30]

I will try calling my insurance again tomorrow. I didn't have much luck with answers before. I got lots of "We can't answer that question." stuff from them. I should just be patient. I'm going through the Barix Center in Ypsilanti, MI so I'm sure they know their stuff since it's all they do. I'm just terrified of what the answer may be. I've re-read my insurance documents for the 1000th time today. I have a $3,000 co-inusrance maximum for me or $6000 co-insurance maximum as a family and then $6600 out of pocket max for me or $13,200 out of pocket max for the family as a whole. I wish I knew someone who was an insurance expert. Haha.

[Sharon1964 2,530]

Okay, when you call your insurance company, ask them if there is a separate out-of-pocket max for bariatric surgery. If the person doesn't know, have them get a supervisor.

[momma_missie 30]

@@Sharon1964 Thank you!! That's a great way to word it and get my point across! Amazing how someone else can put into words what you could never say alone... you rock!!

[Sharon1964 2,530]

No problem! And remember this...

[momma_missie 30]

UPDATE: The hospital called me today. I owe about $2400 in co-insurance to make my co-insurance maximum. I only need $1300 at my pre-admission testing and I'm good to go. Everything else can be done in payments afterwards. I am SOOOOO excited!! The tears have flowed since I got the phone call. God is SOOOOOOO good!!

[BrownEyedTxGirl 139]

Yeah!!! I'm so excited for you!!!

[Sharon1964 2,530]

AWESOME!!!