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BCBS MI Coinsurance

JK92097

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JK92097    0

JK92097
Posted

I am so confused !

If my insurance policy states that I have to pay 50 % of my surgery.

But, I have an " Embedded coinsurance maxiumum" individual / family $3000 / $6000

Deductable of $500/$1000

Out of pocket maximum $6600 / $1320

BCBS of Mi Simply Blue PPO

How much should I plan on paying ?

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Tobeornottobe    89

Tobeornottobe
Posted

I would call the customer service number for clarification. It all gets confusing with the maximum out of pocket vs having to pay 50% of the cost. Someone would be better able to give you guidance.

Good luck.

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JK92097    0

JK92097
Posted

I tried calling. It just made me more confused. The insurance lady at the hospital is confused for some reason too. I am being quoted between $10000 and down or $49000

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Susan66    128

Susan66
Posted

I am so confused !

If my insurance policy states that I have to pay 50 % of my surgery.

But, I have an " Embedded coinsurance maxiumum" individual / family $3000 / $6000

Deductable of $500/$1000

Out of pocket maximum $6600 / $1320

BCBS of Mi Simply Blue PPO

How much should I plan on paying ?

I'm confused with that to.

Usually you would not have to pay anything more than your

"out of pocket maximum" once you meet that dollar amount.

I can't see you having to pay any more than that amount even if you have a co-insurance responsibility.

Do you have a broker you work with that maybe can help explain the policy better? If not call back tomorrow & tell them to explain it to you again.

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Tobeornottobe    89

Tobeornottobe
Posted

Also if it's through your job, speak to someone in HR or a benefits manager at your company. If all else fails, call the insurance company until you get someone who can clarify and explain in layman's terms the information you need.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
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