Jump to content
×
Are you looking for the BariatricPal Store? Go now!

BC/BS Michigan PPO - Individual Plan



Recommended Posts

Hi all,

I am brand new to this forum... though obviously, not new to weight management (and failure thereof!)

I *finally* made the 7-year in the making decision to get a Lap-Band. All things considered, this is the correct WLS for me.

Here's my stats:

F/41

Ht: 5'6"

Wt: 350

BMI: 56.5

I have struggled, on the "books" with my weight, since about 1980. So... past medical history is with me.

I've been over 300# for about 13 years.

I decided to go and see a Surgeon in my area that came highly recommended. He does 2-3 Lap-Bands/week, and actually has a band himself.

When I went in for a consultation, I presented my Insurance Card, which is BC/BS Mi PPO, and the office staff assured me that everything would be covered, because I meet all the requirements.

Apparently, however, this applies to the same plan with GROUP coverage. I have INDIVIDUAL coverage. The individual policy does not cover.

My surgeon's office is filing an appeal for medical necessity, and I sent in a 3-page personal medical history, including all of my ailments, meds., etc.

Unrelated: I am currently having serious pain in my pelvis. I have had an ultrasound and a CT scan. The ultrasound came up with nothing. The CT scan didn't show any problems in my pelvis; however, it does show a lesion on my spleen... too large to be a cyst, and I've been referred to a general surgeon for further evaluation.. read: surgery + biopsy.

My Lap-Band surgeon of choice is a General Surgeon. He agreed to do the biopsy of my spleen while he does the lap-band.

I asked the doctor's assistant if we could do the spleen (possibly spleenectomy?) as a covered procedure, and I'd pay the lap-band OOP... she said "perhaps" and that it would be about $5200.00.

So... this is where I sit. Because I was under the impression that I covered, I had the pysch eval, and am in the midst of having sleep study (totally have sleep apnea!) and a cardiac clearance. The bills haven't started rolling in.... yet.

I'm looking for any advice I can get at this point. I've waited myself out for 7 years making this decision..... I honestly don't want to wait 5 more minutes to get this rolling.

Thanks for listening,

Karen

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×