Natasha Estrada

Officially got my day. First thing in the morning christmas eve. Had been hoping for a little sooner but 2 weeks more wait isn't too bad.

I had the same kind of Blue Cross *** plan when I got my gallbladder out and it was $250 admit and I only paid that. I kinda wish I had that plan now though mine did not allow bariatric surgery.

You could try contacting the department that handles managed care in your state. If the insurance has promised the hospital that they will pay the claim at 100% I really don't see what their issue it. Try sending an email to the hospital ceo.

I have the same deal $25 a month for all the Vitamins and the nascobal.

Well here's the thing too. By law they have offer the same plan at the same price off network so you can buy the plan you like directly from the company. That way your the customer #1. Though I do believe the reimbursements seem to be about the same but I believe it a lot of cases its the insurance companies NOT inviting the doctors to be on their panels rather that the MD's saying no.

I got the Blue Shield PPO Ultimate which is the same as the platinum on the covered california exchange. I chose to purchase directly through blue shield because I had heard that the exchange plans have narrower networks

Glad to hear it only takes 10 days for approval. I finished my final requirement today and the daft girl at the desk told me 2-6 weeks even though I had been told 4 days to 2 weeks by the coordinator at the start. I have Blue Shield PPO individual plan.

I haven't been told anything either. I'm assuming I would be since they were pretty upfront about the fact that I would have to pay in cash for the psych evaluation. I pay 10% but 10% of what they won't really know until after surgery since they may or may not do a hernia repair at the same time. Also depending on who bills first the surgeon or the hospital one will be fully covered since I only have a certain amount to go before maxing out my copay max. I have no deductible. I used the same surgical group and hospital for my gallbladder surgery and no one asked me for anything up front then. So I can't see how this would be different. I have Blue Shield of CA

Honestly rather than being self pay considering that open enrollment is coming up you might want to purchase your own plan directly from the insurance company. Usually individual plans allow bariatric surgery. It's often that the employer based insurances that don't offer it. I bought the best plan Blue Shield offers at $325 a month and it covers it so with the cost of premiums and about $2k in copayments coinsurance a year it works out to be about $6k total for everything the surgery the insurance and all my other medical expenses. I was getting a worse deal getting it through my husbands company at $275 a month but my medications cost $60 more a month. We have choices now so its nice.

Yeah this month is the end of my insurance required D&E visits. Last one on the 28th I've had my preop meeting with surgeon a few weeks ago. As soon as my file is ready to go it'll be sent to the insurance. She said even though I didn't want a date in December to get it sent straight away so I can get the date I want. It's probably not the surgeons being busy but how many OR's available at the hospital. For this same surgical group I saw a surgeon on a thursday and had my gallbladder out on the monday. My Dr took a month off in May so I assume she works all December. I feel sure I'll get a date since I'm on track for a November one anyways and thus will have my pick before those on track for December but I think December is busy bc ppl want to get the surgery before the end of the year and the reset of deductibles.

I'm hoping for a December date. I'm actually on track for November but want till wait until after finals (December 10th) My file goes to the insurance on October 28th. I'm hoping that will be enough time for it to come back and then book a date. Does everyone already have their dates already?

No advice to give to you but I have the exact same plan so this worries me though I'm a first time preop patient getting the sleeve.

My doctor and the whole surgical group no longer recommend lapbands. One of the older doctors will not perform them anymore. It would be good to analyze how many lap bands are perform in "centers of excellence" and other similar reputable facilities vs how many are done in side of the freeway advertised clinics. My question is how Rosie only claims to have lost 50lbs. Is it because she doesn't want to admit what her highest weight is?

Have any of you seen Freelee the banana girl's videos. She recommends you to eat 30 bananas a day and to carb the F up Check it out on youtube it's crazy funny in a bad way.

This is good to know. I don't know how true the following statement will end up being but my preop weight loss goal is 30lbs. I'm coming into my 5th visit in 2 weeks this one with the surgeon. I don't know how strict they will be. I'm making all the lifestyle changes but they haven't resulted in lbs lost.

I have been set the target of losing 30lbs 10% of my starting weight. It's been stressing me out a little because after 2 months of supervised DE I've only lost 6lbs. My NUT told me not to stress out too much that it's not set in stone. My original target date for surgery was November but I want to have it after the second week in December so I can have the time off.

I switched to an individual plan when I become eligible in March so I could get the surgery covered. Will probably switch back to my husbands plan at the start of the new year.

I'm lucky that the WLS preop education program for my surgeon is free of charge. That includes all the nutrition and preop classes, dietitian and support groups. The only thing that they told me I'd have to pay upfront for which was for the psych clearance which I did. I should ask next time I'm there but I find sometimes I forget. Also they have a lot of HMO patients so the way payment is handled for them is different. I know when I went to the seminar I was the only one not referred by a particular IPA.

OK looked at my plan and its a 10% coinsurance of the total amount. I only have $x left for the year before my copay is maxed out and they start picking 100% so I'd prefer not to have to pay upfront and have to fight to get it back. Already though not their fault they have overcharged me for my office copay so I should have a small balance.

What is the difference? Is copay when its say $20 or a fixed dollar amount and co insurance when it's a percentage? I guess I'm wondering is how will they know what the amount will be without billing the insurance if its a %

I won't need monthly payment if I can pay when a normal bill would be due. It'll be interesting to see if they do handle copays differently for bariatric surgery than the rest of their payments. It's a huge practice so wls shouldn't be that different. As I mentioned prior to I had my gallbladder out with one of the other wls surgeons in the same practice and billing was afterwards. I hope they would say something because they gave advance notice about having to pay up front for the psych. I dont even know how much the copay would be anyways only that its 10%

Yes I know this is a question to ask directly of the office but they haven't mentioned anything so fat other than I have to pay 10% and I was wonder if your surgeon made you pay before surgery. I'm hoping not since my surgery will be right before bonus time so was planning to pay for it with that. I DID have surgery with one of the other surgeons in the office (gallbladder) and didn't pay anything until after the fact. My copay might will also probably max out after surgery with either the surgeons or hospital bill depending on which gets paid first. So you experiences?

I wouldn't because Imodium affect peristalsis of the bowel and that's one of things they are concerned about post surgery. Your bowels will naturally slow down because of the anesthesia so you don't want to add the imodium on top. Paralytic ileus of the bowel is no fun at all.

If it isn't one of the things they ask you to do post operatively then I would ask they prescribe it to you anyways. A few pricks for a few days is much better than blood clots in your lungs.

Good to know. Though BlueCrossBlueShield is not the same as Blue Shield. Each state is differnent. My friend found this out the hard way because she has BCBS issued out of CT and assumed she could use any BlueCross of California doctor. Not so much. Had to send her this video. I should clarify I'm not intending to keep anything from my pcp I just dont want to have to make an appointment just to discuss it