Insurance....

[tripletmomma2000 3]

Hi gang!

I'm not sure if you guys remember, but I have BC/BS PPO Michigan, individual coverage. They just removed all bariatric procedures from their coverage this past January 2009. They said it is just not covered.

My doctor CALLED them this past Friday, and I'm not sure who he talked to, but my status moved from "denied" to "pending".... my agent who is my liaison with BC/BS told me they don't cover, no exceptions... however, it looks like they might actually consider this?

I'm not going to hold my breath.... I'm probably going to have to pay somewhere about $6-8K for the procedure (I'm getting hiatal hernia surgery along with it) out of pocket, which I was prepared for... but can I actually HOPE that my insurance company is going to do what's right, and cover this for me??

I am not getting my hopes up... but it sure would be nice not to have to pay that much $$ for my surgery!

I'm taking prayers where I can get them!

Karen

[TiffanyP 0]

Three Cheers 4 Karen ! ! !

Healthy Hearts R Happy Hearts. Congrats on the good test results.

I wish I had some big girls to get in the way of my results - heehee. I have only lost 15 pounds so far and the hubby has already commented on the shrinking of the girls. If he isn't liking it now, he really isn't going to like it in 6 months. heehee!

Congrats Again! ! !

[formerfatchick 1]

Karen,

That's great news !! I something dont get the insurance company and their thinking...surgery..what maybe $15K at most...not covering it means ALOT more expense for them in co-morbidities and such..so shouldnt it be a no brainer that this would save them money in the long run..DUH !!!

But I digress..here's hoping that it all works out and that you can take the money and go vacation in Hawaii with your new body next year !!:thumbup:

[lotusflwr 0]

So how come 6 to 8 thousand??? In my area it runs 15 thousand. That's why I am going to Mexico!

[mom2boys3 0]

I hope the best for you. Hopefully it will get paid for!

[tripletmomma2000 3]

It's going to cost somewhere between $5200.00 and less than $10K, because I'm also having hiatal hernia surgery/possible splenectomy as well.

I just talked to my insurance company, which said they denied the entire surgery, because LB is included in it. So, my Dr.'s office will probably re-submit for hiatal hernia and splenectomy.

I will let you guys know what happens.... I'm getting a bit annoyed at my Dr.'s staff however. I've been asking them for over 2 weeks what the actual cost is going to be if I have to cover the LB myself, the doctor says "$5200.00... little more, little less"..... staff says "probably a little more... not sure".

WTF?

Of course, you know, the hospital and doctors want to get paid BEFORE they even do anything.

Out of exasperation, I called and asked if they'd take a credit card, since they can't seem to tell me how much $$ it will cost. That way, I don't have to take $$ out of savings right away. Once I pay for everything, I can pay off the credit card with the $$ from savings.

To say I'm not in the mood for any of this shit is putting it mildly.

Oh..... and BC/BS MI individual PPO's reason for not approving any bands after January 2009? People abusing the insurance, and just opting for it to get the surgery, and then dropping the plan.

HELLO....... I've been on plan nearly 2 years now.... pretty sure if I was going to abuse it, I'd have done it already!

[tripletmomma2000 3]

No surprise, insurance said NO.

However, since I'm having hiatal hernia surgery as well, I got a grand total for what I need to pay for the band:

$6000.00

The band itself costs $5200.00.... so they are only charging me $800.00 to put it in!

I'm grateful that that's all I have to pay. But don't think I'm not going to appeal my insurance's decision!