Insurance - Page 2 - ThinnerTimes

bldsukr · 12-20-2006, 07:43 PM

Hey Everyone!!
Im New To This Site And Have Only Been Looking Into Getting The Surgery. I Called My Insurance Company-ccn- To See What The Requirements And Coverages Were. They Said The Surgery Is Covered But Not The Doctor Visits To See If I Am Eligible For It. So That Made No Sense To Me. I Have To Pay Out Of Pocket To See The Dr. And Hope He Says Im Overweight Enough?? Any Insight Will Help

ladytonya · 12-20-2006, 08:27 PM

Type of insurance used: BCBS of NC
How long did it take for approval: a day and a half
Out of pocket expense? $3,750 ($750 deductible plus $3,000 yearly maximum out-of-pocket expense. This will very greatly depending on your company's plan.)
Special Requirements: at least 100 lbs. overweight, BMI under 40 with co-morbidities. 5 documented years of being overweight (I thought this was stupid. I weighed 457 lbs. I didn't get that way overnight!)
Unusual Circumstances: None
How would you rate/would you recommend this insurance carrier: Very highly

Kanuka · 12-21-2006, 05:07 PM

Type of insurance used: BCBS of MD PPO
How long did it take for approval: Still in process 5/6 mons. Insurance coverage does not indicate the 6 month requirement. I think the Dr's office is trying to take all necessary precautions for approval.
Out of pocket expense? To date (5 months in the process) $220. $100 needed for surgeon at time of surgery and $10 facility charge and one more supervised visit totals = $350
Special Requirements: 6 month supervised diet (so says the Dr's office, not written in the BC/BS Coverage book).
Unusual Circumstances: None to mention, will submit for approval in late Jan. How would you rate/would you recommend this insurance carrier: Yes. Blesses to have insurance that would potentially cover it.

Kanuka · 12-21-2006, 05:11 PM

Dr's office without any pre-quaifying conditions like hypertenison or diabetes will not be covered. The Dr's office can not file a claim for Obesity alone, they must be able to file it for a certain co-morbity in order for it to be paid by insurance. It all relates to ICD codes (billing codes).

Rachel · 12-21-2006, 05:36 PM

Quote:

Originally Posted by bldsukr

Hey Everyone!!
Im New To This Site And Have Only Been Looking Into Getting The Surgery. I Called My Insurance Company-ccn- To See What The Requirements And Coverages Were. They Said The Surgery Is Covered But Not The Doctor Visits To See If I Am Eligible For It. So That Made No Sense To Me. I Have To Pay Out Of Pocket To See The Dr. And Hope He Says Im Overweight Enough?? Any Insight Will Help

Maybe I am taking what they said the wrong way... Did they mean you would have to pay the entire amount to visit the Doctors? or just your regular co-pays? I know my surgery is covered completely, but all of my co-pays still apply to everything. Meaning when I go get blood work I pay, x-rays I pay, Meet with the surgeon I pay, etc. Just like I would if it was any other problem I was having. I am interested in this... keep up posted

Good luck!!

Oh make sure you do all of your research to know what the requirements are BEFORE you go in to meet with them. That way you can make sure to have all the necessary information with you at that time... Like other diets tried with the dates and amounts lost, if there was re-gain. When you first became overweight. Go in armed with TONS of information. That is my advice

bldsukr · 12-21-2006, 05:57 PM

Hey Rachel,

Thanks for the advice. I didn't think to do that, be armed and ready!!
I need to call my insurance again to clarify on that because I think maybe the lady who told me that was having a bad day. It just doesn't make sense to have to pay for the whole visit....isn't that what insurance is for?
And by the way, we share the same name!!

218/210/150
highest/current/goal

jeezy · 12-22-2006, 05:24 AM

Type of insurance used: Coventry of DE
How long did it take for approval: 6 mons. (Cust. rep said there was no 6mos waiting period when I was shopping for insurance (11/05).
Out of pocket expense? $100 for psych eval., est. $500+. for co pays, program fee, prescripts & possible $850 for bloodwork (went to work lab for test! filing appeal.)
Special Requirements: 6 month supervised weight loss visits (what wgt loss? Total waste of time. Had to get of BC pills!

Unusual Circumstances: Had to take blood test twice b/c of elevated white blood cell count - 3 days before surgery! Thank GOD it wasn't the arterial blood gas test!
How would you rate/would you recommend this insurance carrier: Considering the surgery cost about $13,500 & my cost was $20---7.5 out of 10./ Would I recommend....bah! all insurance co's are a bunch of shysters. Choose wisely whatever the carrier.