Amanda611

Hang in there, Lulu!! I am sorry that you didn't get the news you were hoping for, but you have the right attitude that will help you succeed. I was initally told I was going to have to get down to a 55 BMI before they would do the surgery; however, my surgeon decided I was okay to have surgery since I had already lost 65 lbs on my own. Before, I was put on a strict diet by them when they wanted me to lose weight, and it consisted of a protein shake in the morning, a snack 100 calories or less, a protein shake for lunch, a dinner that couldn't go over 350 calories and 25 carbs, and a snack in the evening at 200 calories or less. I actually found a wonderful protein meal supplement powder called Nectar. They have many different flavors, and they are the best I have tasted. I now also use light regular flavored soy milk in my protein shakes. If you decide to use the surgeon that you are using, see if there is some type of diet/eating guideline you can follow to help you lose your weight. Keep it up, and reach out if you ever need to vent, need advice, etc YOU CAN DO IT!!!

This is pretty much along the same lines as your copay question. It depends solely upon how the policy is set-up. Some policies are set-up to allow any amount paid toward the deductible to apply to the out of pocket max while others have a seperate deductible and a seperate out of pocket. For example, on my insurance I have a 1000 deductible and a 2000 oop but my deductible applies toward my oop so in reality I would only be paying a total of 2000 versus 3000 if they were figured seperately. It does appear that since your oop is lower in comparison to your deductible that they are seperate and that yes, your total amount that you could be responsible for paying would be 4300.00.

It depends on how your policy is set-up. Some policies stipulate that copays go toward deductibles while other policies exclude copays. You will want to check with your health insurance.

Deductibles are very confusing to explain so I hope that I don't confuse you ever more Your health insurance deductible is something that must be paid by YOU before your insurance will pay anything toward your medical claims. There really isn't anyway to pay off your full deductible without accumulating claims. Each time you go to the doctor, hospital, etc, and you use your insurance you are essentially creating a medical claim that the doctor or hospital bills to your insurance company. From there, your insurance company will determine how much they will or will not pay based on your benefits. So for example, you have a 3000.00 deductible and you go to the hospital and the hospital bills your insurance company 1000.00 for that visit. Your insurance company processes the claim and sees that you have not met anything toward your 3000.00 deductible so they will not pay. They will then notify the hospital who will in turn bill you for the 1000.00. At the same time, your insurance company will deduct the 1000.00 that you are paying the hospital off of your deductible so you would only have 2000.00 left toward your deductible to meet. The confusing thing to most people is that you are NOT paying your health insurance company this deductible, it is an accumulation over time that you are paying to various doctors. So to answer your question, your 700.00 hospital bill should go toward your deductible reducing it down from 2525.00 to 1875.00. So would have 1875.00 left to meet before your insurance would start paying any portion of your claims. If you are still confused, it is best to call your insurance company and have them explain this to you and also, you can familiarize yourself with your benefits because sometime even after your deductible is met you may still be responsible for a portion of the claim. Good Luck and if you still have any questions, let me know

You will have to ask your new employer. Generally, start with someone in human resources, or someone that administers your benefits at your new company. They should be able to tell you if they cover anything related to bariatrics, or direct you to their insurance that they offer for you to be able to check. Most insurances cover bariatric related services; however, sometimes depending upon the employer, they are able to decide whether they are going to cover weight loss related services or not under that particular plan. For instance, the coverage I currently have is through BCBS of Illinois with my current company and they DO cover bariatric related services; however, my husband's insurance through the same insurance company DOES NOT cover anything related to bariatric services at the request of his employer. Hopefully, you work for a company that has a benefits administrator or HR department and you can get the information that you need. Good Luck!