MandaPierce

I have Capital Blue Cross PPO Plus and the word on the street is that it's good insurance. Different testimonials I've come across say that CBC covers WLS but I'm having a hard time finding out what comes out of my pocket and how to get the ball rolling....Do I call my insurance? Do I set up a consult with the weight loss clinic first and let them duke it out??

I'm a newlywed so until recently, I didn't have insurance for many years and it all confuses the hell out of me.

I'd hate to set up the consult and find out I need to fork out a grand in co-pays that i don't have....

Please help!!!

VTMoondog

I've got BCBS as well. I'm insured in a rather large group (Burlington City Employees) and on that plan, there are two tiers. We belong to the higher tier, the "preferred" benefits...therefore a higher premium...BUT, everything, all pre-op tests, procedures, the operation, hospital stay...everything, was paid for 100%. All i've had to fork over is co-pays.
While I of course love BCBS, it all depends on the level of coverage that you have, relative to your company's negotiated coverage, as to how much dough you'll have to shell out. Hope this helps.


scott

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Heaviest/Current/Goal
310 243 190
Lost Since surgery: 33lbs
Surgery Date: 4/9/08 - Lap RNY

Gym Rat #94

SimplySamaria

I also have Blue Cross Blue Shield (Empire) a large network too. You first just call them up.. see if you are covered and how much coverage you have. They should also be able to tell you if there are some things you must do first.. like doctor monitored diet plans (some times 3-6 months) counceling there are all sorts of hoops you may or may not have to jump through. My insurance covers 80% of it. I do the rest. So start saving your pennies now!! Good luck!

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Samaria
Pre- Op

SueRN

First, you need to find out about your own policy. You need to look at the benefit booklet and that should tell you what your co-pays are, deductibles, out of pocket max, etc. It should also tell you if there are any exclusions that the employer has requested. Just because the insurance company covers it, does not mean that your particular policy covers it. Also, if you have been without insurance, you may have a pre-existing clause. Obvioulsy, obesity would fall under this. That means that there may be a period of time, some up to 18 months, that any pre-existing conditions would not be covered during that time frame. Calling customer service for the insurance company may not be all that helpful as the person may not know or have access to all the details of your policy. And some just plain old don't even look. You really need to review your benefit booklet. This should be provided by your/your spouse's employer. Let me know if you have any add'l questions. I work for BCBSNC and have (and still do at times) review gastric bypass surgeries so I'm very familiar with the process. Sue