BCBS AL (PEEHIP) - out of pocket expenses?

[darby0375 18]

I saw my surgeon for the first time a couple weeks ago and paid an office-visit copay. I logged into my insurance and saw that BCBS denied the claim for payment of the remainder of that charge. I'm jumping through hoops to get insurance to pay for the surgery itself, but now I'm wondering what other out-of-pocket expenses will there be? I'm planning on the copays each month that I go for my PCP-supervised diet and I know I have to pay for meeting with the nutritionist...but what else? Does this mean I'll have to also pay for my sleep study? Ugh!

[sunnkistme 76]

Not sure about your BCBS policy but for mine I had to jump through a few hoops too. My surgeons office insisted I confirm coverage under my policy complete with a name and number of the person I spoke to. Some BCBS policies require that you have surgery at a "Center of Excellence". This became an issue for me when there was not a COE within one hundred miles of my home so the surgery was covered at the same rate that any other surgery would be covered. Your best start is with your insurance and request the written policy be sent to you. Coding makes a big difference too. My policy does not cover "obesity". Only related conditions. I am still trying to get the coding on a 1500.00 test changed to the one the insurance will actually pay for.

[blondebomb 580]

I saw my surgeon for the first time a couple weeks ago and paid an office-visit copay. I logged into my insurance and saw that BCBS denied the claim for payment of the remainder of that charge. I'm jumping through hoops to get insurance to pay for the surgery itself, but now I'm wondering what other out-of-pocket expenses will there be? I'm planning on the copays each month that I go for my PCP-supervised diet and I know I have to pay for meeting with the nutritionist...but what else? Does this mean I'll have to also pay for my sleep study? Ugh!

who is your ins thru? I have BC/BS an before I even had my first visit I had to preapproved for bariatric period. was you pre apporoved? an then did you see the surgeon? bc everything that you go thru ..your testing..etc..your ins should be covering bc certain Ins carriers require certain tests. an if your preapproved for bariatric it should be covered. I would call your ins co an ask questions of what they are covering an if not 100% I would want to know what I am expecting to pay out of pocket. I was pre approved an after having all done ..2 months later I started getting some bills. an mine was 100% covered. I had to call Ins an tell them they needed to resubmit all the accounts I was getting which I had 4 bills I recieved. but after telling them that I went ahead with this not only bc of several drs recommending this BUT that also ins aproved it from the beginning! you shouldnt have to pay for anything UNLESS you have a deductible that has to met first. I hope you get this straightened out before hand. every dr is differant. I didnt have to do a sleep study for the surgery but I did have a sleep study a yr an half before...hope you get some answers..

[blondebomb 580]

I saw my surgeon for the first time a couple weeks ago and paid an office-visit copay. I logged into my insurance and saw that BCBS denied the claim for payment of the remainder of that charge. I'm jumping through hoops to get insurance to pay for the surgery itself, but now I'm wondering what other out-of-pocket expenses will there be? I'm planning on the copays each month that I go for my PCP-supervised diet and I know I have to pay for meeting with the nutritionist...but what else? Does this mean I'll have to also pay for my sleep study? Ugh!

I was just rereading this...your surgeons office should have done all the talking for you an got everything in order! thats what the office staff is there for is talk to them in your behalf....I didnt have to do anything before surgery. they took care of it all...

[tart 21]

I had BCBS and found that I got the best answers from talking with their customer service.

[Rena's got this 274]

My workplace is self insured, but BCBS of Alabama administers it using their requirements. I had to pay a copay for my sleep study and my nutritionist visits (not my PCP monthly diet sign-offs, since I wasn't required to come in and see her for those). I was unpleasantly surprised by my psych bill. I had to pay for all of it. I never quite figured out whether or not it was required, but I went ahead and did it anyway. For the actual surgery I only had to pay the $100.00 hospital copay.

[Brasherx2 0]

I am so thankful to read your post! I came to this forum to connect with others dealing with the same issues I have encountered with BCBS of AL. I too have been denied for the claim of my 1st month supervised diet visit, my initial bariatric Dr. visit and lab work required by the bariatric surgeon. These three claims total almost $800. I learned from a BCBS customer service rep that these claims were denied because the diagnosis given was "obesity" and my policy does not cover obesity treatment. I took a minute to scratch my head over this news. BCBS clearly defines the steps to take for surgery approval and I am following these steps exactly but it appears I may now be responsible for 100% of the cost of these 7 Dr visits and possible the sleep study because the diagnosis given was obesity. I am now waiting to hear from the insurance coordinator at the surgeons office to review this information with her. I was VERY careful to educate myself on the insurance requirements prior to beginning this process...so this information is shocking. I am completely prepared for the months co-pays($30) and hospital facility co-pay($150) but not for 100% these visits. I would love to hear if/how any fellow bariatric pals may have overcome this obstacle.

[darby0375 18]

I talked with BCBS and was told the same thing. I'm just at a loss all the way around. My policy requires 3 years of medical records to be submitted. Because I have a single BMI less than 35 back in 2013, the insurance coordinator at what I thought would be my surgeon said that even I satisfied all of the other requirements, I would be denied for coverage of the surgery because of the "low" BMI. So I feel like my journey is over before it even began.

I am disappointed in that the insurance person doesn't even acknowledge that yes, denials can happen, but that is not always the final answer. I feel like a valid case could be made for approval since all my other BMIs (back to 2008) are above 35 and I have comorbidities. I don't know if they just choose not to advocate for their clients because they offer (and push) a cash payment option. If I was a betting person, I would think they make more off cash payments than insurance.

I don't want to totally give up, but cash paying isn't an option for me. At this point, even if I did have the money, I think I would find a different surgeon. I am sorry this is somewhat long and a diversion from my original post...I was/am so frustrated with the whole process I have just thrown my hands up in the air.

[Noname22 175]

I am so thankful to read your post! I came to this forum to connect with others dealing with the same issues I have encountered with BCBS of AL. I too have been denied for the claim of my 1st month supervised diet visit, my initial bariatric Dr. visit and lab work required by the bariatric surgeon. These three claims total almost $800. I learned from a BCBS customer service rep that these claims were denied because the diagnosis given was "obesity" and my policy does not cover obesity treatment. I took a minute to scratch my head over this news. BCBS clearly defines the steps to take for surgery approval and I am following these steps exactly but it appears I may now be responsible for 100% of the cost of these 7 Dr visits and possible the sleep study because the diagnosis given was obesity. I am now waiting to hear from the insurance coordinator at the surgeons office to review this information with her. I was VERY careful to educate myself on the insurance requirements prior to beginning this process...so this information is shocking. I am completely prepared for the months co-pays($30) and hospital facility co-pay($150) but not for 100% these visits. I would love to hear if/how any fellow bariatric pals may have overcome this obstacle.

@Brasherx2I know this is a older post but can you tell me if BCBS AL went back and paid for your initial visit if you were approved for the surgery? Mine didn't pay for the first visit either, but I was told to wait by the office coordinator because sometimes BCBS AL will go back and pay for the very first visit.