TracyinKS

I have BC/BS of SC, and I am expecting on the high side my cost to be around $3000. BUT I have an HRA plan (not an HMO or PPO) My plan is where I have a pool of money $1125 and if I use that I have a bridge (fancy word for deductible) of another $1125, then it goes to 80/20 plan. SOOOOOOOO what I did was put money in a Flex Spending Account to make up for my bridge and the extra...... this way I will have it all paid for with pre-tax money and paid for in a year.......... and if for some reason this flops..... everyone is getting a giftbasket with OTC stuff for christmas next year! LOL Please keep us posted on your progress........ it is how we learn

It's now the wednesday.. my consult is Monday the 8th.... I mentioned in an earlier post that I had upped my FSA to cover my out of pocket max... I did this right before bcbs mailed out the cards, and yesterday they still showed the lower original amount, but I emailed them and today it is fixed.... this means that i'm going to have quite a bit of flex dollars to use... I swear if this flops everyone is getting baskets of OTC meds next year for Christmas. LOL This is also what I've done: 1. a copy of my "weight loss" chart starting from after the birth of my son in 2003... (It goes up and down ALOT) 2. a timeline of me in pics, starting in 1998.... (I go up and down a lot) this is to prove that YES I've TRIED, Failed, Tried, Failed 3. A copy of the letter from my OBGYN.. which goes back to 2000, listing my struggles with my weight and infertility 4. Copy of my last Thryriod panel... 5. List of all the drugs I take and the dosage Things on my to do list are to pull my bank statements with my CURVES membership on them, and now that I think of it, I have an OLD Ballys membership too that shows up on my credit report.... I'm trying to DO everything, just in case the docs offices makes me do a precert, or if I have to do battle

Sounds like you have a plan! Welcome! This place has been a wealth of info for me... JUMP IN AND POST OFTEN

Wooooooooohooooooooooo skinnymom! can't wait for your updates!

Find out if your company has changed its policy... start with your Human Resources office, and then if you know for sure.. go ahead and file the claim but also be ready to appeal it. Find out what the appeal process is, and I've read on here that some have even appealed with their state board of insurance and ended up getting it approved.

Kerry: that is just simply FRIGGEN AWESOME!

1. Are you insured or are you self pay? 2. If self pay, you just need to find a surgeon you like, attend a seminar, and get going. 3. If you have insurance.. you need to find out if WLS is covered. Start with the HR person at your company. If they don't know, have them ask their corporate office. 4. IF it is covered call the insurance company to find out what is required. READ, READ, READ this board.. I know I have found SO MUCH INFO! I am going through the process right now too... so you are not alone.

More as of today!!!! I did get a call back from the supervisor person and she APOLOGIZED about the confusion. She said I was indeed correct, I did NOT need a pre-cert for my CDHP plan.... (YIPPPPPPPEEEEEEE) but she cautioned me to go ahead and do one anyway just to make sure there isn't any problems with the billing... (I'm thinking in my head. YEAH RIGHT, give me my band and I'l deal with billing issues later!) SQUEAK!SQUEAK! I just emailed the insurance coordinator for my surgeons office breaking down my insurance plan. I hope to hear back from her with a break down of what is going to be expected out of my pocket.... (It would be a dream come true if I could push all this through and get my band by the end of January)

Nicole: Thanks for the compliment..... I did get a call back from the supervisor person and she APOLOGIZED about the confusion. She said I was indeed correct, I did not need a pre-cert for my CDHP plan.... (YIPPPPPPPEEEEEEE) but she cautioned me to go ahead and do one anyway just to make sure there isn't any problems with the billing... (I'm thinking in my head. YEAH RIGHT, give me my band and I'l deal with billing issues later!) SQUEAK!SQUEAK! I just emailed the insurance coordinator for my surgeons office breaking down my insurance plan. I hope to hear back from her with a break down of what is going to be expected out of my pocket.... (It would be a dream come true if I could push all this through and get my band by the end of January)

Lots and Lots of info on going mexico! there is also a doc in denver that does it for about the same price..... I think it is lapbandrockies dot com or something close... do a search, and I'm sure you'll find your answers! good luck

Congrats on your band! I can't wait to join you in bandland

Update: I've been posting my insurance progress over on the insurance thread..... Here is my latest: I bit the bullet and called the customer service number on my card and they transfered me to MANAGED TIER, which deals with precertifications. I just went round and round with a workerbee, and then the supervisor... they both told me that I would indeed be required to be approved, and have to go through a precert. (My ID card says NO PRECERT Required) and our Open Enrollment Booklets clearly highlight it (on page 16) I read it to her..... I explained to her that we have 3 plans 2 PPO's and 1 CDHP, the CDHP is what I have...... (I also quoted back an email from the Tiffany person)....... this made the supervisor backpeddle and she is now reasearching it..... (She said.. well it's obvious you know your benefits, and I said, yes.. it's MY JOB, for my company.) I also quoted our SPD requirement of BMI requirments. I told her that I have my consultation with the surgeon one week from today, and I have been working with the program coordinator to make sure everything goes smoothly... she did say that it was investigational.. and I said, it is no longer investigational...as of November 2006, and it under billing code: 43770............. THIS WHEEL IS A SQEAKING BABY!!!!!!!1 I will update when I know the outcome.....

I don't know if anyone but me is keeping up with my battle..... but here is the latest... I bit the bullet and called the customer service number on my card and they transfered me to MANAGED TIER, which deals with precertifications. I just went round and round with a workerbee, and then the supervisor... they both told me that I would indeed be required to be approved, and have to go through a precert. (My ID card says NO PRECERT Required) and our Open Enrollment Booklets clearly highlight it (on page 16) I read it to her..... I explained to her that we have 3 plans 2 PPO's and 1 CDHP, the CDHP is what I have...... (I also quoted back an email from the Tiffany person)....... this made the supervisor backpeddle and she is now reasearching it..... (She said.. well it's obvious you know your benefits, and I said, yes.. it's MY JOB, for my company.) I also quoted our SPD requirement of BMI requirments. I told her that I have my consultation with the surgeon one week from today, and I have been working with the program coordinator to make sure everything goes smoothly... she did say that it was investigational.. and I said, it is no longer investigational...as of November 2006, and it under billing code: 43770............. THIS WHEEL IS A SQEAKING BABY!!!!!!!1 I will update when I know the outcome.....

Happy New Year! Since my last update I have recieved the letter from my OB's office stating my history with obsesity and the scripts they had given me, my battle with PCOS and infertility.... Also, since it is the new year I went and created my profiles with BCBS and found out that the amount in my FSA is wrong.. so I've been emailing them waiting for an update...... I have an HRA, and on my card it clearly says NO PRECERTIFICATION is required....... so I'm wondering if I would be borrowing trouble if I called them and made sure they knew it........ ONe week from today I will be meeting with the surgeon... I'm so excited but also anxious.

My mom has anthem out of KY... and I'm HOPING this holds true for her!

welcome and good luck, look forward to your progress reports

OK.. if he is not for the lapband.. find another doc!!!!!!!! there are plenty of great surgeons who mainly do the band now. Some docs are slow to change their mind, or heck it might even be a money issue.. it costs a lot more to have the bypass.. whatever his reason... SEEK OUT ANOTHER!

Yeah.. I'm wondering too what slower is.... I figure heck even if I lose 30 lbs a year, that is better than gaining... and the band isn't going away... but I HOPE once banded that I will drop weight FAST.. LOL (yeah right)

Ok go to your Human Resources Department, ask the person who knows the most about your benefit plans.. ask to see a copy of your medical SPD, which is also called a PLAN DOCUMENT, this is usually a big book of mumbo jumbo details that could put you to sleep in a heartbeat.. LOL, but a provision or exclusion for bariatric surgery is in there.... if this does not work, ask your benefit person to contact the main benefits person at your CORPORATE OFFICE.. they will know.... don't be intimidated about doing this, they are just people who get paid the big bucks to KNOW what is covered or not........ It is true... the insurance will cover what your company ALLOWS them to cover, but really it sounds like you are getting the low level run around..... you need to be proactive about nailing down the details. I will say this .... I am the HR person for my company, and I am the go to person for all the employees.. I myself HAD NO CLUE THAT WE COVERED IT.. not until I went to a train the trainer meeting where I actually had a one on one conversation with the VP of HR for our corp office...... so it can happen to the best of us.... just push for the answer and don't feel bad about it OK?:biggrin1:

CONGRATS! Look out 2007 here you come!

Welcome! Lap Band is not the easy way out.... a just a bit of reading on these boards should convince her otherwise, but that said.. this is YOUR journey not hers. I look forward to hearing your updates

WOW!! what a story! Congrats on all that you have accomplished! I look forward to joining you

welcome and happy new years eve!

Lee.. you have to do this for you and not your mother....... others in our life love us but they are usually the ones that sabotage our efforts the most...... be strong and know that you are making this journey for YOU.

CONGRATULATIONS!!!!!!!!!!!!!!!!!!!!!!!!