lafrogura

I haven't had a family physician for the past 6 years or so but i have gone to the gyno every 6 months religiously for my entire adult life. So i had my gyno doc write a letter that said since i've been seeing her, which is only for the past 6 years, what my weight range has been for that time - whether or not she recommended lap-band for me and what the outcome might be for me if i did not have lap-band. My doc sent that to BCBS with my weight watchers info (my weigh in stickers). The surgeon sent a letter also recommending me to have the surgery based on my exam and consult with him. In 3 business days, it was approved. NO questions asked. But the pre-requisites from BCBS were 6-month physician supervised diet, psych consult, nutrition consult. I did have the psych and nutrition consult but no physician supervised diet and they still approved it. I have BCBS of Texas PPO. I get banded tomorrow.:party:

Have you personally called your insurance company? Usually when the patient calls they take it more seriously and mysteriously find the documents. Send them certified or fax and talk to a supervisor if you need to. If you get involved calling them, it will get done much faster

:tt2:I'm being banded tomorrow by Dr. Collier with Journeylite. I'll let ya know how it goes.

Use an in-network doctor and in-network hospital and the most you have to pay is the $2500, minus the 142.15 you've already met. Your doctor and the hospital can charge you above and beyond what your insurance "allows" if they are not on your insurance plan network. Out of network you will pay 40% plus the difference between what the hospital/doc charges and the amount your insurance allows. In-network you will pay only 20% of what the insurance allows. No more. So if you go to an out-of-net doc/hospital, they might charge $30,000 to your insurance, but your insurance might say only $5000 is allowed. So the rest will be billed to you. Not a very good route to go since you have a PPO. Make use of your insurance and use your PPO benefits. You pay to have that benefit so you aren't charged an arm and a leg. that's how you keep your cost down. If you do choose an out-of-net doc/hospital, then make them cut you a deal. They can do that since they aren't contracted with your insurance. They don't have to collect your deductible, etc. The hospital i work for, honors patient's in-network benefits if we are not on their ppo plan. That means, we only charge them the co-insurance (20%) and do not collect their deductibles. We write them off completely. There are a lot of hospitals out there doing that and the doc should do it, too. Let me know how it goes. Also, for your out-of-pocket max, you can apply for Care Credit. It is a health expense credit card. If you pay it off in a year, there is no interest. You can apply at www.carecredit.com ... Just make sure the facility accepts it. Most of them do. Or you can go through capital one.. they finance a lot of healthcare for very low interest rates. If you want more info, let me know.

i chew ice. or i put ice in the blender with a splash of milk and some fresh fruit. it's fast and there's not really an extra calorie intake.

Of all the places to have pain, i wouldn't think her back would be one of them. I understand maybe her shoulders where the gas floats up trying to escape. If she has any shortness of breath with the back pain, i would go straight to the ER. I haven't gotten banded yet, i will be on July 14, but if i had back pain, i would personally be concerned about post-op complications. Take it seriously.

:rolleyes2:I agree! That sounds like frauuuud... even if your insurance covers it, there's no reason for them to charge you that much up front. If you really want to use that doctor, then i suggest you call your insurance and find out what your responsibility is for the hospital and the surgeon and see what you have to pay up front (eg, deductible, copay, co-insurance) .. that way the insurance can tell you "you have a 500 deductible and then insurance pays at 80% until you meet your maximum out of pocket expense.. i do medical billing for a hospital and there's no way that doctor can charge you that amount unless he is not in-network on your insurance.

worth a try!! go to the website and apply! don't give up ...

Yes!!!! that is exactly what i'm talking about .. except mine lasts from about 2 days before my cycle, the entire 7 days of my cycle and then for 2 days past my cycle .. almost half the month .. celebrex helps .. aleve helps somewhat also.. but it is crippling for sure !!! :smile:

I've been on Metformin now for 2 months for PCOS. I haven't noticed any difference in my periods, nor have i had any side effects from the Metformin. It is supposed to help with the hormones. The doc also put me on birth control pills so i won't ovulate since it is unbelievably painful to ovulate with PCOS. I thought with PCOS you couldn't ovulate but your ovaries try and it causes pain like you wouldn't believe. I don't know anyone else with PCOS, but has anyone else experienced this kind of pelvic pain during their period? It is absolutely not menstrual cramps, i can deal with cramps. :wink2:

Have you applied for Care Credit? It is a healthcare credit card with very reasonable interest rates (starting from zero % depending on the length of time it takes you to pay it back) and lots of payment plans. Just go to www.mycarecredit.com ...

I use Dr. Patricia Choy. She practices at Women, MD in Webster Texas right next to Clear Lake Regional Medical Center. She is about an hour away from where i am living now since i've moved but she is worth the drive. I have been seeing her since 2002 and would highly recommend her to anyone. She is fantastic!