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BCBS (Pos) just told me they will pay 100%....AHHH

MeganES

By MeganES, in Insurance & Financing

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MeganES    41

MeganES
Posted

I'm not sure if it's too good to be true or if it's really happening!! I have my consultation with my surgeon next week. The woman I scheduled it with took my insurance info and said she'd call me if there were any problems. I hadn't heard from her but my mind wouldn't get off the topic, so I decided to call the insurance company (Horizon BCBS-NJ pos) myself just to know what direction I'd be heading in. I was told they will pay for everything in full - 100%!!!!!!! I'm in tears!!! I'm not telling too many people about my surgery yet (only told my dad, aunt, and 2 best friends), and I wanted to share the news with people who will really understand how much this means. Now I really see why these forums are so great!! I CAN'T WAIT for this journey to lead me to a new life!!! :)

~Megan

Kimmy1813, Jerzygurl, MIJourney and 1 other reacted to this

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Pookeyism    1,143

Pookeyism
Posted

Wow! Now act like they are going to pay nothing, and make a 'payment' each month (to yourself) and you will have your plastics covered in no time!!! :P

desertgirl6801 reacted to this

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MeganES    41

MeganES
Posted

Pookeyism - LOL!! I love the way you think! I just might do that :)

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SuzyB    182

SuzyB
Posted

That is awesome. My bc/bs pays it all but my inpatient copay which will be around $500. It will be the best $500 I have ever spend.

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Jerzygurl    372

Jerzygurl
Posted

I'm not sure if it's too good to be true or if it's really happening!! I have my consultation with my surgeon next week. The woman I scheduled it with took my insurance info and said she'd call me if there were any problems. I hadn't heard from her but my mind wouldn't get off the topic, so I decided to call the insurance company (Horizon BCBS-NJ pos) myself just to know what direction I'd be heading in. I was told they will pay for everything in full - 100%!!!!!!! I'm in tears!!! I'm not telling too many people about my surgery yet (only told my dad, aunt, and 2 best friends), and I wanted to share the news with people who will really understand how much this means. Now I really see why these forums are so great!! I CAN'T WAIT for this journey to lead me to a new life!!! :)

~Megan

Megan,

We have the same insurance...and yes they pay 100% as long as the doctor is in Network. So far, I've only been responsible for a co-pay to see the WLS and my PCP, other than those two, I haven't spent a dime at all..and it's a blessing to have such great insurance with no Bariatric exclusion. I'm also at the finish line and hoping for an October surgery.

Oh and one other thing, I'm not sure if you know or even if it applies to your coverage but BCBS requires three visits to the doctor's office in three separate months. By that I mean, it used to be you had to go through a 6 month supervised diet program, but they've since made it much easier. Now it's only 3 months.. so for me, my doctor's appointment in Aug counts as 1 visit, then my appts with the psch or Nut will in Sept counts as number 2 and then my 2nd appt with the NUT in Oct will count as my third consecutive month of appointments...then I will be able to get surgery.

Anyway...Best of luck!

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MeganES    41

MeganES
Posted

Jerzygurl - thank you so much for letting me know! When my cousin did it she had to wait the 6 months. I'm glad to hear it's been changed to 3 months! I was hoping to have the surgery done in the mid/end of December (during winter break from classes) so that works out very perfectly. Thanks!!

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Jerzygurl    372

Jerzygurl
Posted

Jerzygurl - thank you so much for letting me know! When my cousin did it she had to wait the 6 months. I'm glad to hear it's been changed to 3 months! I was hoping to have the surgery done in the mid/end of December (during winter break from classes) so that works out very perfectly. Thanks!!

If you're looking at winter break then it's good that you're starting now. Make your appointments quickly, the sooner the better.

I noticed (pos) at the end of your BCBS is that (point of service)? I missed that before. I'm definitely Horizon-BCBS-NJ but (Direct Access). Not sure how big of a difference there is between the two, but I still think the change from 6 months to 3 months apply to all BCBS bariatric coverage.

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MeganES    41

MeganES
Posted

If you're looking at winter break then it's good that you're starting now. Make your appointments quickly, the sooner the better.

I noticed (pos) at the end of your BCBS is that (point of service)? I missed that before. I'm definitely Horizon-BCBS-NJ but (Direct Access). Not sure how big of a difference there is between the two, but I still think the change from 6 months to 3 months apply to all BCBS bariatric coverage.

Thanks for the tips! I'm going to try to get through everything as fast as possible. I've got my PCP appointment scheduled for tomorrow. From what I understand after that (and after the consultation) I'll just have the nutritionist, psychologist, and the EGD, so that should cover the 3 months. awesome! :) Yup, POS means point of service. I think the only difference is that i have to get a referral from my PCP for every specialist I go to, sometimes a little inconvenient, but I wouldn't dare complain about that because I'm (we're) truly blessed with amazing insurance.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      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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      1. LeighaTR

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    • Alisa_S

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      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.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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