BCBSNC coverage

[bnicolexo 9]

I have BCBSNC. My policy covers the surgery, I've read over requirements and have found tons of information

What I'm not completely sure of is my out of pocket expenses

I know my deductible and my out of pocket limit, are those amounts combined for me to pay or is the out of pocket limit what I need to pay?

I have yet to make an appointment, trying to cover a lot of ground before I get my hopes up

Hope my question makes sense, I'm a bit confused :/ lol

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[Nicetomeetyou 82 41]

Typically your pay your deductible once that is met you pay a percentage of the bill until you reach your out of pocket. Then the company pays 100%.

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[Glorivina 1]

I have BCBSMA. After I started my appointments and got some information from my bariatric surgeon. I called my insurance and they told me exactly what my responsibility would be. They needed the Dr's name and the hospital that the procedure would take place at.

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[Theotherkels 14]

I also have BCBSNC - definitely depends on which type of BCBSNC policy you have. When my son was born we were on an 80/20 plan, we ended up being responsible for 20% of the cost, we'd already met our deductible at that point so this went towards our out of pocket (I believe). The nice thing about most hospitals is they let you do a payment plan without charging interest....I joked that we had to pay off my son like you'd pay off a car.

Have you gone on the BCBSNC website (blue connect) and put in your plan and looked up an estimated cost for a procedure based on your plan. Once you've chosen your surgeon/hospital you should be able to do that too and that might help give you a better idea

[sandokat 9]

I have BCBSTX and I know that the out of pocket max, is the most you will pay for the year. Log into your portal and see if your plan is 80/20 or 90/10. If your deductible is less than the max out of pocket, typically the insurance covers a portion (80 or 90%). I don't know about your plan, but with mine, the family deductible is met by whoever/however gets there first. So for mine, I have $1300/person deductible. then 6000 out of pocket max. Since my husband and I are both on the plan, I have to meet $2600 before the insurance kicks in and pays 10%. Once I reach $6000 for the year, the insurance will pay 100%. So my surgery is 1/4/17. That is a whole new deductible for me and I have already paid the surgeon $2860 and the hospital $870. The hospital was only half though and I will owe another 870 before my surgery day. That is just for the surgery. Then I will be billed for the recovery and care after. (2-3 days)

Hope that helps!

[Theotherkels 14]

also often Anesthesiology and Radiology are billed separately so keep that in mind as well when calculating total costs. Still definitely worth it...just have to prepare for the financial aspect!

[bnicolexo 9]

Thank you all for a response. The information was helpful! My new policy became effective today and I was able to log in and get an estimated cost. Does anyone know how accurate that tends to be?

[Theotherkels 14]

Thank you all for a response. The information was helpful! My new policy became effective today and I was able to log in and get an estimated cost. Does anyone know how accurate that tends to be?

I haven't had my procedure yet so I'm not sure....I'm waiting to hear back on my approval. You can give BCBSNC a call to ask more detailed questions if you like but I'll warn you that the hold times right after the new year were pretty bad last year....I'm talking like 5 hours + just to get a human on the phone.

I'm also in NC...can I ask where you're looking to make your appointment? I'm going through Duke health.

[bnicolexo 9]

How long have you been waiting for an approval?

I think I will pass on calling for now lol, I'm okay with the information I have for now

I'm looking to go through Bariatric Specialists of NC located in Cary

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[Theotherkels 14]

So I'm actually working towards a revision which is a bit different than just starting a fresh journey. I started seeing my surgeon in April 2016 and putting together all the records of my compliance while banded, as well as test results of an endoscopy, an upper GI, a sleep study etc.

Essentially we have to make a really good case as to why they should pay to have the band removed (because I've developed health related problems with it) and why they should pay to revise to the RNY (because I have a history of compliance and success....at least prior to my wonky thyroid and pregnancy).

We just now go all of the records and tests and everything together, I got my psych clearance right before Christmas and I emailed my surgeon's nurse to see if things have been submitted.

Both duke and bariatric specialists of NC are marked as bariatric centers of excellence - I looked at them when I was doing initial research and ultimately chose duke because my primary is in the duke system and so I wanted my doctors to easily be able to share information and be on the same page when it comes to my health.

My surgeon did mention that BCBS was changing their bariatric policy after the new year, the requirements on how long we are required to be enrolled in a surgical center's program. I believe it used to be 6 months, and they are moving to 12. In my case I don't know if it will apply because I'm a revision...but if it does it means I'll have to wait until after April for my procedure. It will suck if I have to wait but it's worth it and in the meantime I can continue to focus on making the lifestyle changes I'll need.

I would definitely check with BCBS to find out what the new (if any) changes to the requirements may be so you've got a game plan for the coming months

[bnicolexo 9]

So I'm actually working towards a revision which is a bit different than just starting a fresh journey. I started seeing my surgeon in April 2016 and putting together all the records of my compliance while banded, as well as test results of an endoscopy, an upper GI, a sleep study etc.

Essentially we have to make a really good case as to why they should pay to have the band removed (because I've developed health related problems with it) and why they should pay to revise to the RNY (because I have a history of compliance and success....at least prior to my wonky thyroid and pregnancy).

We just now go all of the records and tests and everything together, I got my psych clearance right before Christmas and I emailed my surgeon's nurse to see if things have been submitted.

Both duke and bariatric specialists of NC are marked as bariatric centers of excellence - I looked at them when I was doing initial research and ultimately chose duke because my primary is in the duke system and so I wanted my doctors to easily be able to share information and be on the same page when it comes to my health.

My surgeon did mention that BCBS was changing their bariatric policy after the new year, the requirements on how long we are required to be enrolled in a surgical center's program. I believe it used to be 6 months, and they are moving to 12. In my case I don't know if it will apply because I'm a revision...but if it does it means I'll have to wait until after April for my procedure. It will suck if I have to wait but it's worth it and in the meantime I can continue to focus on making the lifestyle changes I'll need.

I would definitely check with BCBS to find out what the new (if any) changes to the requirements may be so you've got a game plan for the coming months

I'm starting fresh, I have been without insurance so I have been waiting. Self pay has been so expensive!

Not from experience, but from reading on here insurance companies can be tough to deal with. Hopefully you get approved, I think you will!

I also have a wonky thyroid. Hypothyroidism

I have seen BCBS updated their policy on the website, however I haven't seen a timeframe for that! I have seen the timeframe for tests and such, but none about a supervised diet

I know on the website for Bariatric Specialists of NC they do notify you of changes if you have BCBS about a 6 or 12 month program, but it's not in the policy. It confuses me, but I will find out eventually! Hoping it's not a 12 month thing, I can live with a 6 month program lol

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[Theotherkels 14]

I'm starting fresh, I have been without insurance so I have been waiting. Self pay has been so expensive!

Not from experience, but from reading on here insurance companies can be tough to deal with. Hopefully you get approved, I think you will!

I also have a wonky thyroid. Hypothyroidism

I have seen BCBS updated their policy on the website, however I haven't seen a timeframe for that! I have seen the timeframe for tests and such, but none about a supervised diet

I know on the website for Bariatric Specialists of NC they do notify you of changes if you have BCBS about a 6 or 12 month program, but it's not in the policy. It confuses me, but I will find out eventually! Hoping it's not a 12 month thing, I can live with a 6 month program lol

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*wonky thyroid solidarity fistbump* - I was diagnosed as hypothyroid about 6 years ago, levels have finally been steady for about a year...I feel best if my TSH hovers around 1.8-2.5...if I go higher than that I feel like dirt

Self pay is SO expensive...I was self-pay for my first procedure because even though my BMI qualified, I didn't have at least two comorbidities that my insurance required for me to be approved. Being self-pay definitely made it more challenging because all my fills were out-of-pocket...any support services. Hindsight being what it is, I'd have chosen a different route....but you live and you learn right?

Do you know of any WLS support groups in the area? I know the Duke program has them in Durham and Raleigh but I'd love to also find something closer to where I am (holly springs area).

[bnicolexo 9]

I'm starting fresh, I have been without insurance so I have been waiting. Self pay has been so expensive!

Not from experience, but from reading on here insurance companies can be tough to deal with. Hopefully you get approved, I think you will!

I also have a wonky thyroid. Hypothyroidism

I have seen BCBS updated their policy on the website, however I haven't seen a timeframe for that! I have seen the timeframe for tests and such, but none about a supervised diet

I know on the website for Bariatric Specialists of NC they do notify you of changes if you have BCBS about a 6 or 12 month program, but it's not in the policy. It confuses me, but I will find out eventually! Hoping it's not a 12 month thing, I can live with a 6 month program lol

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*wonky thyroid solidarity fistbump* - I was diagnosed as hypothyroid about 6 years ago, levels have finally been steady for about a year...I feel best if my TSH hovers around 1.8-2.5...if I go higher than that I feel like dirt

Self pay is SO expensive...I was self-pay for my first procedure because even though my BMI qualified, I didn't have at least two comorbidities that my insurance required for me to be approved. Being self-pay definitely made it more challenging because all my fills were out-of-pocket...any support services. Hindsight being what it is, I'd have chosen a different route....but you live and you learn right?

Do you know of any WLS support groups in the area? I know the Duke program has them in Durham and Raleigh but I'd love to also find something closer to where I am (holly springs area).

Over the years my TSH levels have been checked, they were normal to slightly elevated at time, nothing that concerned anyone until July of 2016 my TSH was 27!!

Self pay was terrible! I wouldn't recommend it to anyone. But you definitely live and learn, it taught me how valuable insurance is and I'm so happy to have it!

I have not checked into any information other than the facility and insurance info. I'm in Sanford. Apex and Cary aren't too far, I'm going to try to see if I can find any in that area

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[KWeilbrenner09 88]

I have bcbsnc and at my first appointment they outlined all the costs for me. I had my surgery on 12/26 so I am still waiting for hospital bill

Katy W- Louisburg, NC

Lapband revision to VSG with DS

HW- 297

Weight at Surgery-279

CW- will update at two week appt

[Theotherkels 14]

I feel like I should clarify, self-pay was terrible only because it made aftercare and support very difficult because everything was out of pocket and that presented more challenges than I expected

@@KWeilbrenner09 congrats on your surgery! I hope recovery is going smoothly for you

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