Bcbs Of Al - Costs - Mobile Infirmiry

[bormannk 40]

BCBSAL is my insurance and it covers 80% of the surgery, surgeon, tests and hospital. Quilifiers are the usual, High BMI, serious health relates issues and 6 month medical supervised diet - which I am on my second month... I can't wait!

I am a single mom and naturally I am trying to plan as well as possible the costs of my surgery. I know hwo much my surgeon will cost, but I can't seem to find out the cost of the hospital, at Mobile Infirmiry. Anyone here has any idea of how much does Mobile Infirmiry average cost is for about a 48 hour stay/surgery? Naturally, I know it could be between 15,000 and 30,000 and it depends on how you do, if there are complications... Just looking for an educated ballpark!

Please tell me your story, if you too have had Gastric sleeve at Mobile Infirmary! I am getting ready for mine! Thanks!

[Rena's got this 274]

My surgeon actually gave me a form explaining exactly the amount I would need to pay after insurance. You may want to ask your surgeon for something similar. My insurance is BCBS of AL also. My paperwork is in review right now...

[bormannk 40]

Hi Rena! Yes, I know exactly how much my Surgeon will be (Dr. Ringold - who is your doctor?)

But I was curious about the hospital stay. we have to pay 20% of the total cost of the hospital as well... That is the cost that is most concerning. Right now looks like $3000 - $6000 would be my portion... that is a big difference!

Thank you so much for your reply!

[Rena's got this 274]

My Dr. is Dr. Wes Turton, with West Georgia Bariactric. He does the sleeve almost exclusively.

If you will look at the back of your insurance card, you will find a number for the BCBS customer service. Call them and ask them how much you will have to pay for a one day hospital stay. If you tell them it is Mobile Infirmary, they may be able to tell you exactly how much your portion will be.

My brother was treated at Mobile Infirmary years ago after a workplace accident (Oil Rig). They saved his life.

[bormannk 40]

Hi Rena!

I wish you the best of luck!! Let me knwo when you get your approval!

I called the number. they said they can't tell me what my cost for the hospital will be, only that i wll have to pay 20% of the total surgery cost, and my deductible, which is $600 upon registration.

[Rena's got this 274]

That makes it difficult to plan. I know that the average total cost is around $21,000.00 but I don't know what all that includes. Lordy...if I had to pay that much, I'd just forget it and go to Mexico!

[bormannk 40]

Well, you and I have the same insurance... does your 2013 says everything is 80/20 for Bariatric or are you being 100 cover after copays?

[Rena's got this 274]

I work at Auburn University. We are self insured, but BCBS of AL is the administrator. We have different coverage than anyone else using BCBS of AL. I've been told that everything will be covered except for $100 for the hospital copay. If they take their time and don't approve me before the end of the year, and I am not able to have the operation before the end of the year, I will have a 2014 deductible to meet, but it is only $150.00.

[Rena's got this 274]

Sigh....I've been denied. Now starts the process of appealing their decision. If all else fails, Mexico may be my next step. I've heard you can have the surgery by an excellent physician for less than $5,000.

It is either this surgery, or knee replacement surgery in another year or two. I'd rather lose the weight and keep my knees!

[bormannk 40]

Oh No Rena!! Why??? did they explain why? That is such BS...

I am really sorry to hear that - what is the process to appeal?

[Rena's got this 274]

This is what they said in their denial letter.....

According to the information sent to us, the patient’s condition does not meet the medical criteria guidelines established by our medical staff for the above procedure(s). The documentation does not show a BMI of 40 or greater or BMI of 35 or greater with a co-morbid condition and on optimal drug therapy for three years. Per Blue Cross and Blue Shield of Alabama®’s Medical Policy #053, co-morbid conditions include hypertension on optimal drug therapy, atherosclerotic cardiovascular disease, diabetes on insulin or oral agents, pulmonary hypertension, or severe sleep apnea with RDI of 50 or greater. Also, the six month consecutive diet must be supervised by a practicing physician such as the primary care physician and not by the bariatric surgeon. The diet received was supervised by a registered dietician only and does not meet criteria under Medical Policy #053. Please note, letters only are not accepted.

You may request one reconsideration of this predetermination. This request should be made in writing. Please include any additional medical documentation available for this reconsideration that has not been reviewed.

[bormannk 40]

Hi Rena

I am sorry it's taken me so long to reply. I am baffled about the response you received. That is really awful of them. Are you requesting re evaluation or are you jsut going to go to Mexico?

Basically they wait until you are in a real bad shape before approving. And a diet followed by a nutricionist is ten times better since they are trained for that. It makes no sense. I am sorry.

What is your next step?

Wishing you the best of luck!

[Rena's got this 274]

My next step.....appeal. I've called my primary care doc and asked her to submit notes for each of the dietitian appointments I've been to. She indicated that it wouldn't be a problem.

After my surgeon gets her notes, he will forward them to BCBS along with his thoughts on why this surgery is necessary for me, and if needed he would request a peer-to-peer review. So, I'm keeping my fingers crossed, and hoping I won't have to dig into my retirement funds to make the trip to Mexico.

[bormannk 40]

Hey Rena - When will you know the result of your appeal? I am sending prayers your way and hope it goes quick. I can imagine how you are feeling but I know you will figure out a way to make it work.

I am pretty nervous about being elegible too, and I called my doctor's insurance specialist. She reviewed my files again and assured me I should have no problems becuase of my over 50 BMI history for the last 4 years, but since I do not have a weight on records for 2012, I am still worried (Even though worry will not help me at all).

Let me know how things are going !

[gracefulrayne 0]

I am in Daphne and having the sleeve with Fr Ringold at Mobile Infirmry too. I have info on costs tho, not even surgeon fees. Can you tell me what your surgery will cost? I have been approved but chickened out twice, blah! I'm going through with it this time for sure.