Cloteal

The physc evaluation was not done through your program. As far as I know I will have to pay for the nut and maybe 55.00 for the physc eval. I just want to know what I need to do so i can get the ball rolling.

There's another lady on the forum that went through Dr. Enoch's office, she said she had her eval done by a Psych Dr. at Dorothea Dix for $55.00, and she had it done on her own. I'm pretty sure you can contact that physician to schedule an eval to atleast get that portion done.

Yes, I have BCBS of NC and Mass

Good for you. You should be straight then on your coverage. You shouldn't have to pay anything out of pocket. I'm concerned that I'll have to pay my deductible prior to my surgery. I believe that's $600, I just paid $300 for my phych eval. Times are really hard right now. I probably shouldn't complain because there are some whose insurance won't cover any part. I just thank God, for what my insurance will cover.

Well, I thought that I would be using Dr. Moran in Raleigh but I can't seem to get a call about how much my insurance will even pay. I realize that the holiday may have played a major role in this process and that I am so excited. If I don't receive a call before long I might consider going to another doctor. My emotions on this are rather scrambled right now and don't know which way to go. Maybe I am have not allowed enough time to pass before I should even be considering a change in surgeons. I just want this process to go as smooth as possible. I have already spoke with my insurance company and know that it is covered on both plans.Any suggestions would be greatly appreciated.

Do you have more than one insurance carrier?

When you went for the seminar and the office sent in the paperwork, how long did it take for them to contact you. I went to the seminar and the paperwork was sent in the same day. I guess I am on pins and needles because I want this so bad. I was trying to get all of these appointments out of the way since we are out of school right now. Looking at about three more weeks before I return to work. I guess i am just rushing the process. I have been so pumped up about this since I attended the seminar. really just want to be healthier and not so heavy. I work in a modified year round school. Next month we go back around the 16, actually it is less than three weeks the more I think about it.

Who did you decide to go through to do your surgery?

Hello, I have BCBS of NC and I am having my surgery done in Lumberton (Southeastern Regional Medical Center). I guess it all depends on the person and the situation, regarding how long it takes for approval. I was approved the same day my doctor sent in the paperwork. My BMI is like 46.6, and I don't have any co-morbidities. I use to get the B12 shot back in 2007 for about 6 months and lost 45 lbs. I had to stop b/c I became pregnant. I had my son Aug. 08 and gained the weight back plus 20 lbs. I breastfed so I could not continue B12, I went to a seminar at SRMC in May and decided to see if I qualified. After doing my pre-testing I was approved on July 1, and have a date for July 31st.

Our plans changed as of July 1, 2009;

$600.00 deductibles

$60.00 co-pay for specialist

$25.00 co-pay for primary

Good Luck to all and pass the word there is an surgeon in Lumberton!!! (Dr. Barry Williamson)

Congrats to you. Do you have to pay anything up front before you have the surgery?

I went to the seminar last night. Angelica answered all of my questions. It use to be that insurance would deny you the lap band if your BMI was too high (bcbsnc) but not anymore. Also I just need 2 years documented weight history. I was torn between RNY and the lapband. After much thought, and prayer on my part I have decided for the band.

Good for you, I hope all goes well. Keep us posted on how things are moving along for you. I'm still waiting for an approval from my insurance company too. I'll keep you all posted as well.

Well being that said, you guys I guess it all depends on where you go. I was referred to Duke after Pinehurst wouldn't even allow me an appt with their Doc saying my BMI was below 40 and it would basically be a waste of there time. Well, I'm through the final stages of my journey of getting the surgery done. I'm just waiting on insurance approval, Duke has a really great team and they don't mind working. I really appreciate them. Just keep me in your prayers that I get approved. I don't know why I wouldn't my BMI was just a little over 40 and I have high blood pressure, but I am not taking meds for it as of right now. I'm hoping that when I lose this weight I won't even need BP meds. Well I'll keep those informed that want to know what's going on.

I do not think so, it wouldn't make any sense anyway. If you don't need comorbidities for a BMI of 40 it makes no sense that they would require comorbidities for an even higher BMI.

I wonder if you are thinking about something else, some ins co's won't band someone with a BMI of 50 or greater and then some won't do DS until you are a BMI of 50. Could you be thinking of something along those lines?

Maybe that is what I'm thinking about. Thanks. I hope all goes well for her, like you said it wouldn't make sense for them not to do it. I do think it depends on ones insurance.

Parrothead is correct, you need comorbidities for BMIs under 40.

Yes, parrothead is correct about having to have comorbidities if your BMI is under a 40, but if it's more than a 50, I think that's another story. I believe you have to have comorbidities as well if its over 50.

Well today I went for my psych eval, all went well, last about 45 min, nothing to it at all. Now I'm just waiting I guess for insurance approval. Wish me luck and I'll keep you all posted.

Plum, for most insurance and surgeons, the "line" is a BMI of 40 or higher does not require any comorbidities. You are well above that line so you wouldn not have to worry about whether or not you have any comorbidities....except to know that you should be able to kiss them goodbye in the future.

Good Luck

I don't know about that, I think if your BMI is above a 50 you will need to have comorbidities. I would check to make sure.

I am new here and trying to start the process. How did you find out about the seminar.

I called this number 919.470.7000 and made an appt for one of their seminars, they were really nice, of course they were booked, but I called almost every day to see if someone cancelled, what they did was took my name and number and called me when someone cancelled. I had my seminar on 05/12, my first visit with the Dr on 06/15, my Psych eval is sched for 06/30, this is all with Duke. I am very pleased that I went to Duke, of course there are others that you can attend. Good luck to you.

Wonderful! You are moving right along. Maybe you will have your surgery some time in July.

That would be awesome if I did, but I'm not sure how fast they move. I would be happy with a August date. I don't even know if I'm approved yet, well I'll just speak it into existence.

Hi all, I have an update. Well I finally got to see the Physician who will be doing my surgery (Dr. Sudan) YAYYYYYY! Well everything seem to have went pretty well, I saw the nutritionist and took some test (EKG/Chest xray). I go for my PSYCH eval on 06/30 and after that I should be able to get a surgery date if I'm approved. Hopefully I won't have any problems, my BMI was over 40 and I do have HBP. Wish me luck, it will soon be here.

I'm just like the other writer who didn't get charged by their PP, I can't imagine getting charged, I pay my co-pays every visit. That just does not seem fair, but if I had to pay for the letter, I probably would have but complained about it. They don't write the letters themselves anyway,the office manager does and I'm pretty sure it's saved in their computer and all they have to do is change the name and a few diagnosis, etc. Well that said, I hope all is well for you. Good luck and I do wish you well.

Follow your doctors program to the letter. Drink lots of Water as suggested. And, stay busy!

I cleaned out closets, worked in the yard, cleaned out my pantry and got rid of the junk. Start your exercise program. Walk ALOT for the next couple of weeks. Stay out of the kitchen if you can help it. If you have someone else to do the cooking, let them. If you can take your walks while the family is eating, do it. You get some "me" time, and you don't have to suffer through the meals you can't have. Just remember that the pre-op and post-op phase is temporary. It's only a few weeks, and you can do this.

Good luck to you.

OMG! This was well said and very encouraging to me. I have not yet had my surgery, don't have a date yet, but I go see the Surgeon on 06/15, I'll probably get a surgery date then. I too was concerned about the pre-op, post-op liquid, I didn't know if I would be able to do it, but you are such a great encourager, I now believe I can and will. Thanks for that and keep up with the good job your doing.

If you have not already, I think you should investigate a little futher. Check with BCBS youself about the in/out of network Phych. Sounds like they want a lot of money to me. Check with another doctor in Raleigh first before you go all the way with Duke. :wub:

Yes, I will investigate more, but I really believe that Duke will be better for me. The staff at Duke is wonderful, they all are very nice and have great customer service. I didn't have a good experience with Dr. Mitchell's office and heard not so good things about Dr. Enoch's office (meaning staff). So far I'm satisfied with Duke, I know it's a long way for me to drive, but it will be better in the long run.

Hello,

If you look at my numbers you and I are very similar. My height is 5' 3". You BMI is considered obese. Anything over 29 is obese and over 39 is morbidly obese. I don't have any health problems. I have had acid reflux and then I started having swelling in my legs and feet. Because I don't have any health problems, they ran all sorts of test and determined that my upper body weight was too much for my legs. BCBS approved me first try.

Thanks for the encouragement. I am morbidly obese, my height is 5', and I weigh 207. My feet swell sometimes so bad they throb, I'm considered borderline high blood pressure. My doctor says my weight is the cause of increasing blood pressure. I just pray that I get approved, I can't continue like this.

Her name is Tammie Moore. She is located in Cary. Her number is 467-3831. When they answer just let them know you need to schedule a Lap Band Mental Health Evaluation.

My surgeon was Joseph Moran.

Do you have any other health issue? Are you diabetic?

Thank you for giving me that info, I called the Psych Dr. that I'm scheduled to see as I was told that I may not be able to go outside of Duke (left a msg for her to return my call). Oh yea by the way, HAPPY BELATED BIRTHDAY TO YOU (imagine me singing this)haha. Talk to ya later.

My bday was Friday, May 29. I would think you should be able to use someone in network. It makes more sence to do that. Why did you decide to use Duke instead of some one in Raleigh like Dr. Moran or Dr. Enoch?

I loved the Psych that I met with. I know several other people that have used her and were very pleased.

Can you please provide me with her (Psych) name and number. I chose Duke because it was recommended based on the fact that I was borderline BMI. I first was going to Dr. Mitchell in Pinehurst, I couldn't even get an consult with him as his insurance specialist bluntley stated in so many words that I don't qualify. This happened to someone else and they went to Duke and was approved, and they referred me to Duke.

Congratulations! The day you see the doc they will probably go ahead and schedule your labs. The whole process is incredibly efficient to me, particularly after my first experience. The only bad thing was I once had an appointment with my doc, waited 2 and 1/2 hours to be told he wasn't even there!!!! I see him again on 6/8 as well as the psychologist for my 3 month check up. I'm a bit disappointed that I have lost only 35 pounds, then I remember! I've lost 35 pounds!!!!! That is the most I think I have ever lost on any of my many diets. The difference too is that I just can't eat as much as I used to. So far, the only thing that I have eaten that gets stuck is pork, as in barbecue.

Thanks Skep, and I should say congrats to you on your weight loss. You should be proud that you lost 35 pounds , that is a big accomplishment. Keep up the good work.

Where are you at in NC? I paid $30 for my Psych. She was in network for BCBS. I actually have the State Employee Health plan throught BCBS. My Nutrionist was not covered, but I found one at Rex Healthcare for $55. The max out of pocket that I will pay is $1000 (my co-insurance limit).

I live in Fayetteville, but I work in Raleigh. I wonder if I can find my own Psych Dr., or do I have to use one of theirs. Thanks for this information. When were you banded?

Ok, I finally received a call on Friday from Duke to schedule an appt with the surgeon. My first appt is 06/15 with the surgeon, Dr. Sudan, then on 06/30 I see the Psych Dr, I was told I would need $300.00 for this visit (out of network psychs), and when I go again the second visit with the Psych Dr I will need to pay $250.00, which will be reinbursed once I file with my insurance. The Rep that called me said it would be reinbursed, she didn't say at what percentage though, but I spoke with my insurance co BCBS of NC and I believe it will be at 80%.

I just got a bill from REX for $7000 for my portion of the surgery. BCBS of NC covers 80%. I was told the entire surgery would be approx $15,000 but the bill was $27,000. I was a little shocked. Can't wait to see the other bills that come in from the other surgical staff that bill seperately.

Hi Lisa and thanks for your comment it was very helpful. I called my insurance co and yes, you have to meet the coinsurance deductible, plus your outpatient deductible, and they will pay 80% of total bill if your coinsurance has not been met. After all your deductibles have been met they would then pay 100%. That's the way they explained it to me, I was just concerned that I was going to have to pay up front, but Duke said that they wouldn't know how much I would have to pay until I actually had the surgery and they billed my insurance. Did you have to pay for the psych eval or anything else up front?

I did have to pay for the psych upfront. They are out of network. That was the only thing I had to pay for since the rest are in network.

Hi Skep, it's me again, I was told on yesterday by someone who was going through BCBS of NC that her out of pocket fees were going to be anywhere between $2000-$3000. She wasn't going to Duke it was another Surgeon in NC though. I just want to make sure when I go for my appt, that I'm still waiting for that they don't tell me this. I'm prepared to pay for the psych eval. Just need some assurance. Thanks