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Are Fills Coved By Insurance?



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I have Empire BCBS and got approved for surgery but not sure about fills? What the normal policy on this if you insurance does cover the surgery??

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I have BCBS-IL, which I think would be similar and I went round and round with them before I finally got an answer to that question. The answer was that the surgery was approved as medically necessary, therefore any and all "maintenance" required would also be covered.

My surgeon covered 2 months, but the third month got submitted to insurance, and never got processed. My surgeon billed $650 for the fill, and I flipped out at the thought of having to pay that monthly. It turned out it was a "glitch" in the BCBS system, and it ignored claims from my surgeon. My surgeon was fine with waiting - but I was freaking out! I've got my next fill on Tuesday, and I had to demand an answer before I go, cause I can't afford it otherwise. Once it finally got reviewed, they only allowed $410 - but that's still not something I could absorb monthly!

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I have anthem BCBS, and when I called to ask about my bariatric benefits, they sent me a statement which also said fills are covered. I am guessing the fills are at the 20% policy, unless you've already paid your max out of pocket for the year.

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I have BCBS Fed. My surgeron said everything from 3 months after surgery is included in the surgery insurance claim. He said after that I would just be responsible for my co-pay ($25) per visit.

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I have Medicare and they covered the first year of fills. Now I have to pay for them ($160) each. I only go in about once every 6 mths now, so it's not too bad.

Marci

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wow! I didn't realize the fills were that much money!!!!

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BCBS CA Access+ H M O here, after the first year, I just need prior approval for fills and visits to my surgeon. Other wise, I am covered. Approvals take about a week.

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I have to say that I LOVE my insurance, they cover my fills with just my $20 co-pay.

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Does anyone have Cigna health insurance? If so do they pay anything on the surgery and fills? I'm getting ready to get all set up to see if if i'll be able to have it.

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I, also, have Medicare. My fills are at no cost to me, as what medicare doesn't pay, my insurance picks up. And, I don't pay co-pay anymore, either! Before medicre, my insurance covered all fills and offic evisists for 1st 6 months, tehn I had to pay co-pay, but fills were covered, too! Karen

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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