BCBS of Illinois

[lynettecadengo 4]

So I don't know much about how insurance works and was hoping to get some clarification.

I am insured with BCBSIL but I live in Texas and I have not met my deductible yet. I went to my psyc evaluation which showed up on my BCBS account for $500 but I did not have to pay anything out of pocket for that. A little over a week ago I had chest x-rays done, a stress test some type of breathing test. For all three of those I was billed $963 and the nurse who had done my chest x rays told me it was because I have not met my deductible but that it would be applied towards it. I guess my question is why was I billed for the tests but not for the psychological evaluation?

I was also recently approved by my insurance about a week ago. So if I have the surgery will I have to pay full price since I haven't met my deductible or will my insurance cover most of it?

[OutsideMatchInside 10,166]

You have to read your policy we can't tell you. I had BCBSIL and my surgery was covered 100%, plus I had met my out of pocket and deductible for the year before surgery.

Your Eval might have been covered by a co-pay or metal health services might be covered fully. We don't know your policy, they are all different, you have to read it and call BCBSIL with questions. They are nice and responsive.

[karen_marie 220]

I agree with @OutsideMatchInside. I've got BCBS of IL (and live in IL), but it varies from policy to policy. I would think at the very least you would need to pay to your max out of pocket, then insurance covers rest of the surgery cost. Your surgeon's office may be able to help get more information from BCBS of IL, but it'd be better for you to do the phone calls just so you can ask all the questions you need and not worry about anything getting lost in translation.

[lynettecadengo 4]

You have to read your policy we can't tell you. I had BCBSIL and my surgery was covered 100%, plus I had met my out of pocket and deductible for the year before surgery.

Your Eval might have been covered by a co-pay or metal health services might be covered fully. We don't know your policy, they are all different, you have to read it and call BCBSIL with questions. They are nice and responsive.

Thank you I'll definitely call!

[lynettecadengo 4]

I agree with [mention=255228]OutsideMatchInside[/mention]. I've got BCBS of IL (and live in IL), but it varies from policy to policy. I would think at the very least you would need to pay to your max out of pocket, then insurance covers rest of the surgery cost. Your surgeon's office may be able to help get more information from BCBS of IL, but it'd be better for you to do the phone calls just so you can ask all the questions you need and not worry about anything getting lost in translation.

I actually spoke with my doctors office today and got some clarification. As for the rest of my questions I'll go ahead and call BCBS. Thanks!

[Lillyrose130 7]

I called today and ended up being advised to call so many different departments I'm still confused. It is true that they can't just say it costs this much, and you will pay this much. I have a $4,000 out of pocket max each year. They said my plan is zero co-pay and zero deductible. For the pre-testing: EKG, stomach ultrasound, and upper GI, they gave me the "cpt" codes and said my cost of all three would be about $110. I'm thrilled with that. But they also said my insurance covers 85% of the surgery and I pay 15% up to my $4,000 and then they cover the rest 100%. However, not knowing what the surgery costs, how can you know? They said this is just the procedure cost but there is also what the doctor bills, the hospital bills, the anesthesiologist and they may use someone that day that is in your tier 2 (more expensive) so it seems like I won't know until it is done. I am a CHI Franciscan employee so they say I should have good coverage, but would feel better knowing ahead of time as my husband will stress about it until we know.

[dcole007 21]

So I don't know much about how insurance works and was hoping to get some clarification.
I am insured with BCBSIL but I live in Texas and I have not met my deductible yet. I went to my psyc evaluation which showed up on my BCBS account for $500 but I did not have to pay anything out of pocket for that. A little over a week ago I had chest x-rays done, a stress test some type of breathing test. For all three of those I was billed $963 and the nurse who had done my chest x rays told me it was because I have not met my deductible but that it would be applied towards it. I guess my question is why was I billed for the tests but not for the psychological evaluation?
I was also recently approved by my insurance about a week ago. So if I have the surgery will I have to pay full price since I haven't met my deductible or will my insurance cover most of it?

I have BCBSIL through my husbands employer, which is AT&T and live in Georgia. For us all mental health goes through Beacon Health and on the back of our insurance card all of the separate numbers lists the mental health number. But it does depend on your contract. It's best to just call BCBS up and directly ask them.


Best wishes!

Dotty Cole

[Queen Sherri 51]

I have BCBSIL through my husband's employer (Boeing). They have been marvelous! All my surgery costs, nearly 200K billed, were paid at 100%. We have a low yearly out of pocket that had been paid by the time of my surgery in May. BCBSIL has even assigned me a nurse case manager who calls me about monthly. She is a former WLS pt so she's been there.

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge

[dcole007 21]

I have BCBSIL through my husband's employer (Boeing). They have been marvelous! All my surgery costs, nearly 200K billed, were paid at 100%. We have a low yearly out of pocket that had been paid by the time of my surgery in May. BCBSIL has even assigned me a nurse case manager who calls me about monthly. She is a former WLS pt so she's been there.

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge

Awesome!! I have the same insurance. My husband works for AT&T. How long did it take for you to get approved??


Best wishes!

Dotty Cole

[Queen Sherri 51]

They approved in less than 30 days after my surgeon's office sent in the request. I don't remember exactly how long it was, but I do remember thinking it was pretty quick.

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge

[dcole007 21]

They approved in less than 30 days after my surgeon's office sent in the request. I don't remember exactly how long it was, but I do remember thinking it was pretty quick.

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge

Ok so they told me 15 days, but can take up to 30 days.


Best wishes!

Dotty Cole

[Queen Sherri 51]

Ok so they told me 15 days, but can take up to 30 days.


Best wishes!

Dotty Cole

Good luck to you! Be sure you get your fluids in and walk! [emoji188]

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge

[dcole007 21]

Good luck to you! Be sure you get your fluids in and walk! [emoji188]

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge

I got denied yesterday because of my psych evaluation. They said I have too many stressors. I just think they don't want to pay the 100% this year because I've met my out of pocket and they were looking for an excuse. They did this to me a few years ago when I needed a back surgery and then approved it on January 2nd. I'm just really upset over this!


Best wishes!

Dotty Cole

[Queen Sherri 51]

I got denied yesterday because of my psych evaluation. They said I have too many stressors. I just think they don't want to pay the 100% this year because I've met my out of pocket and they were looking for an excuse. They did this to me a few years ago when I needed a back surgery and then approved it on January 2nd. I'm just really upset over this!


Best wishes!

Dotty Cole

I'm so sorry! Please call your surgeon's office right away. They will be your best advocate. You might also call the psych who evaluated you. Perhaps that person can contact your insurance and advocate for you. Best of luck. Hugs!

Surgery - RNY GBP
Surgery Date - 5/16/2017
HW - 368
SW - 352
GW - 150

Sent from my Note Edge