Blue Cross HMO anyone hear of this?

Iluvmyboys · October 23, 2004

I recently had the Lap Band surgery out of the country and called Blue Cross HMO of Georgia yesterday and asked about Dr. referrals nearby. (Thinking I had to pay out of pocket as I was sefl pay for the op) She said that they would cover any Dr. visit......and possibly the fills.....??????

I asked her to repeat it! She said yes, we pay for ANY dr. visit. you just pay the co-pay. I have to get the code for insurance billing for the fill and see if they will pay for a fill locally.....I am SO excited!! We just don't have a lot of money and have 3 little ones so this is like winning the lottery to me. I just hope she is correct in what she was saying. Gosh, it's gona be a good day!

Has anyone heard of anything like this? Thanks all!!

New Hope · October 23, 2004

Wow, that is wonderful news! Isn't it nice that monthly payroll deduction is actually doing you some good?

Alexandra · October 23, 2004

Mrs. P, I wouldn't get so excited yet. The person on the phone probably has no idea that there is no CPT code yet specifically for fills, and has probably never heard of the lapband. I'm not saying it's impossible, but just that you should never take anything you hear from a customer service rep as gospel.

When you get a fill there are a couple of elements to the claim, like the doctor visit plus the procedure itself. Your HMO might, for example, pay for the visit and exclude the procedure because it's not "medically necessary." But whatever they pay for is better than nothing!! Good luck!!

Iluvmyboys · October 24, 2004

Oh dang, drats............darn it...........wah wah wah! I knew it was too good to be true, but I was hoping that since she said it, she had a clue......oh well, just another bump in the road to my old self! Thanks for the wake-up! I'm not to educated in the medical coding/coverage stuff as I didn't even try to have mine covered by me insurance...........due to not a high enough BMI.

lauri · October 26, 2004

Good luck to you, Mrs. P. I have been going through all of the insurance rig-a-ma-roe(sp) for a few months now. When I first started working on it, I was still working and my insurance wasn't as high. Now, I am without a job due to my health problems and I am paying COBRA. My doctor's office just sent the request into the insurance today. We have three children living at home and one that lives with his other parent, as well, and money is tight. I really hope that we can manage to keep up with the payments at least until after my surgery. I am praying that I will find another job soon. My health is much improved because I found out through all of the insurance and doctors requirements that I have sleep apnea! That has been a major reason for so many of the things that were making me so sick!! Too bad I didn't find it out BEFORE I lost my job. I sleep with a c-pap thingy now.

Best wishes to you on your insurance!

leatha_g · October 26, 2004

I'm real glad you've come this far, but it concerns me that you may not have continuing coverage AFTER your surgery. You do know that any new coverage you may get later probably will NOT cover the band since it will be pre-existing, I hope. ?? Also, are you prepared to pay out of pocket for fills and continuing care if you let the COBRA go? I know how exciting it is to think of getting the lapband, but I just want to be sure you understand this is just the beginning. You will have this band for life and things can get a bit costly out of pocket, especially if there are any complications, which we certainly hope you do not have, but are very possible.

Don't mean to rain on your parade, but it something you should seriously be planning for.

I wish you luck with your approval!

lauri · October 26, 2004

Yes, I have thought about it and appreciate your concerns. As a teacher, when I start at a new school, pre-existing conditions are paid. Many schools actually use the same insurance. The last time I changed schools, I kept my same insurance. I truly believe that God will provide a way. He always has. My substitute checks will start coming in soon and that will help.

lapbander081004 · October 30, 2004

In the Beginning...

In the beginning...God covered the earth with

broccoli, cauliflower, and

spinach, with green and yellow and red vegetables of

all kinds, so Man and

Woman would live long and healthy lives.

Then using God's bountiful gifts, Satan created Ben

and Jerry's and Krispy

Kreme. And Satan said: "You want hot fudge with

that?" And Man said: "Yes!"

And Woman said: "I'll have one too, with

sprinkles." And, lo, they gained 10 pounds.

And God created the healthful yogurt that Woman

might keep the figure

that

Man found so fair.

And Satan brought forth white flour from the wheat,

and sugar from the cane,and combined them. And

Woman went from size 2 to size 14.

So God ! said: "Try my fresh green garden salad."

And Satan presented crumbled Bleu cheese dressing

and garlic toast on the side.

And Man and Woman unfastened their belts following

the repast.

God then said: "I have sent you heart healthy

vegetables and olive oil in

which to cook them."

And Satan brought forth deep-fried coconut shrimp,

butter-dipped lobster

chunks, and chicken-fried steak--so big it needed its

own platter. And

Man's cholesterol went through the roof.

Then God brought forth the potato, naturally low in

fat and brimming with

potassium and good nutrition.

Then Satan peeled off the healthful skin and sliced

the starchy center into chips and deep-fried them

in animal fats adding copious quantities ofsalt.

And Man put on more pounds.

God then brought forth running shoes so that His

children might lose those extra pounds.

And Satan came forth with a cable TV with remote

control so Man would not

have to toil changing the channels.

And Man and Woman laughed and cried before the

flickering light and started wearing stretch jogging suits.

God then gave lean beef so that Man might consume

fewer calories and still satisfy his appetite.

And Satan created McDonald's and the 99-cent double

cheeseburger. Then Satan said: "You want fries with that?"

And Man replied: "Yes! And super-size 'em!" And

Satan said: "It is good." And Man and Woman went

into cardiac arrest.

God sighed...and created quadruple by-pass surgery.

And then...Satan chuckled and created HMO

New Hope · October 30, 2004

Greg, funny, but too true!!

QueenMichelle · October 30, 2004

get it in writing-but take what they offer!!! yahoo to you

JDinER · November 21, 2004

Hi!

I just had the surgery done too and I have a PPO Blue Cross and my girlfriend who also had the surgery done a year ago, said the other day that this (PPO blue cross) is paying for all her fills and dr. visits too. So this is both a good day for us. Yea!!!!!

I recently had the Lap Band surgery out of the country and called Blue Cross HMO of Georgia yesterday and asked about Dr. referrals nearby. (Thinking I had to pay out of pocket as I was sefl pay for the op) She said that they would cover any Dr. visit......and possibly the fills.....??????
I asked her to repeat it! She said yes, we pay for ANY dr. visit. you just pay the co-pay. I have to get the code for insurance billing for the fill and see if they will pay for a fill locally.....I am SO excited!! We just don't have a lot of money and have 3 little ones so this is like winning the lottery to me. I just hope she is correct in what she was saying. Gosh, it's gona be a good day!

Has anyone heard of anything like this? Thanks all!! :D

lauri · November 21, 2004

Thank you! And welcome-I noticed you are relatively new to the board. The people here are wonderful. I am so glad to hear that others have had good experiences with BCBS. I was getting worried :nervous ! How are you feeling since your surgery? Do you live in the D/FW area?

lapbander081004 · November 28, 2004

When I retired from the police department I was given the reitrees insurance which is traditional Blue Cross and Blue Shield. When I was working I had Blue Cross PPO.

When I called about the surgery they told me it was covered as long as I meet the requirements which in my case was no problem. Once I got all the paperwork it was approved very quickly. B/C & B/S have paid everything except a few minor costs covering the excersice program and follow up with a nutritionalist. But so far my out of pocket hasn't been over $200.00. And I'd pay lot more then this if I had to.

The cost of our surgery is set up that all visits no matter how many are covered for one year from date of surgery. After that my insuracne will cover visits and fills. Also they have already told me that after one year of being banded they will cover the plastic surgery for removal of an apron if one exsist. All they need is a letter from my dr stating that this surgery is necessary for health reasons.

Sionce I picked up on my exercising my weight loss has slowed almost to a stand still but my body is making adjustments that I like, (lossing inches and flab areas are firming uo). Even my apron isn't falling like I expected it too and it appears if I stay on track I may be able to forgo that surgery. I'd love to have it now as it would probably be an instant 25-30 pond loss. But I'll be happy to try the hard way first.

My problem is that the Police Department where I used to work is being offered a very good contract. One of the conditions is they have to except a change in retirees insurance to Comm Blue I from B/C & B/S. Unfortunatley I don't have a say in this. I understand that the officers are against the city touching anything the retirees have and have opposed this so far. I fear the city will offer them more salary now as the change in the insuracne will save them lots of money down the road. If they chage to the new plan for me I'm not sure what will be covered. Except I do know they have to honor what they have covered up to now.

The city that I work for now gives me $2,000.00+ cash every Dec NOT to take the insurance they offer other ful time employees. Cost them about $7,000.00 a year to have me on the insurance so I understand giving paying me not to take it is sound business.

The insurance in this country is in serious need of overhauling.

December 6, 2004

Has anyone gotten approval from B/C/B/S Federal for lapband? So far, I've recieved conflicting answers. Saying it has been approved on appeal. I live in NH. Thanks

lauri · December 6, 2004

BCBS of Texas here-I have been denied but will be appealing soon. Have you been denied or are you just testing the waters? This is a great place to learn and gain the support you need. Welcome!