Insurance Will Only Pay For 80% If They Approve

[bandready 0]

Well where I'm going I heard that everything has to be paid upfront but I thought that was just if u self paid but idk lol I guess I'll figure this whole process out sooner or later

Where I go wanted me to meet my 300 deductible and pay my out-of-pocket of 3000 up front,they stated that if I meet the both my insurance will pay 100 percent.My question is why dont they file my secondary insurance.They said they would file my secondary insurance and the insurance would reimburse me.I thought about it and went back to the doctors office requesting them to file the secondary first,they did grant my request.

[Krystyneh 55]

I think they are in my network but I'm not positive and I've already paid the $250 fee...I figure that if I do have to pay $11,000 out of pocket that I can set up payment plans but it still doesn't make sense to me so I'm waiting to see what happens. I'll be finding out WHY it costs that much

[difa 114]

shop around...ive never heard of the 100k lapband procedure..no one in my area would charge that...in fact cash buyers are paying 12k....my insurance has it set so that he can max charge 18k to them..and i pay 15 percent of that...look around....i guarantee you that you are getting messed with...either that gal is wrong or they are a con game...call your insurance and they'll tell you what the CONTRACTED amount is with that doctor...I'm sure that gal is wrong.

[Krystyneh 55]

Well the thing is is it's at a hospital. I have WellMark BCBS if Iowa but its PPO and I live in Vermont and I'm having the surgery in New Hampshire. I had state health insurance when I started this whole process. The reason why I have the insurance that I have now is because my husband is an over the road truck driver and the head quarters for the company he works for is out of Iowa. I'm guessing that she's wrong because I've never heard of that. Worst comes to worst I'll pay out of pocket. $11,000 is a rediculous amount to pay out of pocket when I have insurance

[difa 114]

I'm having my surgery at a hospital and I'll pay 3k at the most. There's no way they are charging 100,000 for that surgery.

[Krystyneh 55]

Yeah that's why I'm going to go along with what I need to then when it comes to the cost I'm going to find out how come they charge $26,000 TOTAL for gastric bypass but yet lap band is supposed to be cheaper and they are having me pay $11,000 out of pocket after my insurance pays their 80%.

[MikeinMD 9]

At that rate you would probably be better off flying to Iowa and having the surgery.

[Krystyneh 55]

Yeah that's what I'm thinking but then I have to worry about my fills

[rocky900 4]

You state u have bcbs ia. It really dosent matter which state the bcbs cover is in. If the dr is participating with bcbs in their state they are par with every bcbs

Employers buy coverage in the state thier company is based

A employer can also choose not to cover the weight loss surgery also the bcbs. Oils have a clause that u have to see certain providers like the previous person stated a center of excellence to have coverage. This is how my coverage is if I do not see a center of excellence provider there is no coverage

I would suggest that you personally call the insurance company and ask what the coverage is and what the deductible and max out of pocket that u would have to pay. Also u can ask if the dr ad hospital are in network I think of u go to the lap band site there is a list of questions to ask your insurance. I also got these questions when I went to a seminar for the lap band

[difa 114]

My doctor covers all fills for the first year....

[Krystyneh 55]

The hospital does deal with BCBS and my deductible is $100 and max out of pocket doesn't have a certain number. I guess it's unlimited. They do cover the surgery (my insurance) but I have 3 places near me that do it and the hospital that I chose is ranked high compared to the others

[Krystyneh 55]

Now I don't have to worry about my husband's insurance because he no longer works for the company so they are billing my previous insurance which I'm back on

[difa 114]

and what does your old insurance cover?

[Krystyneh 55]

They cover lap band 100%...it's my state insurance that I pay for...I pay a monthly fee to be on it

[difa 114]

awesome coverage!