If you need help understanding your benefits, I can give you advice from the hospital/facility side of things. Part of my job is to get prior authorizations and calculate how much patients will owe for certain services. I haven't been getting notifications when someone posts on here so if you don't get an answer within 24 hours then send me an email at sseelbach@live.com.

Edited March 13, 201610 yr by Sarah 82

That's thoughtful of you. I may be back!

@@Sarah 82 I have UHC and still uncertain on what they're looking for in the 6 month supervised diet plan. Do they want us to lose? Will we be penalized if we do? I dropped below my BMI of 41 to a 39 for one month but was back up by the next month. So my starting BMI & ending BMI will still be a 41. I appreciate the offer!!

I have the same issue, my BMI is 35, I'm in the supervised diet, i did the diet few days and lost enough to down my BMI to 34, and my insurance do not cover less than 35, so now I'm trying to eat to maintain my weight!! It is too complicated!!

I have the same issue, my BMI is 35, I'm in the supervised diet, i did the diet few days and lost enough to down my BMI to 34, and my insurance do not cover less than 35, so now I'm trying to eat to maintain my weight!! It is too complicated!!

So very complicated! But I get it, I suppose. I think this is to weed out the ones who aren't serious or willing to stick it out when challenges arise. There have been 2 exact times when I thought to myself..."I don't know if I have the energy to keep entertaining this process." But my life matters and it's worth fighting for. So that's what I shall continue to do. Good luck with your process and insurance approval!!

Vey thoughtful of you to offer insurance question help. my husband's BCBS AL insurance needs his weight for the last three years for approval: however he never went to any PHP during 2015, but he went all previous years. How will the insurance do with approval without three consecutive years of weight with him needing approval for 2016 surgery but no 2015 weight? For the past five years, his BMI is well over 50 , he has sleep apnea diagnosis and he is 480 lbs. Being that this weight is well documented for many years , will the insurance still require a 2015 weight? Will they possibly approve without 2015 weigh.

I am so sad because Mississippi doesn't cover Bariatrics!! I can't find any private Insurance that covers it. Please help me.

I have a question for anyone that has had experience with Carefirst BCBS. I am currently enrolled in a PPO plan. The doctor that I am using is out of network. My in network and out of network deductibles ( oon deductible is $3200) will not be combined. If I don't meet my out of network by deductible by the time I am due to have surgery, will I be responsible for paying the surgeon the $3200 upfront? Or how exactly does it work? Any response is welcomed

Thank you SO MUCH for your help! I have united healthcare Mdipa, in Virginia. I'm a federal employee. Do I have to have 6 months consecutive or will 2, 3 month programs qualify me for a sleeve?

Sent from my iPhone using Tapatalk

I have a question for anyone that has had experience with Carefirst BCBS. I am currently enrolled in a PPO plan. The doctor that I am using is out of network. My in network and out of network deductibles ( oon deductible is $3200) will not be combined. If I don't meet my out of network by deductible by the time I am due to have surgery, will I be responsible for paying the surgeon the $3200 upfront? Or how exactly does it work? Any response is welcomed

Your surgeon's office should have already discussed this with you. Mine told me that the hospital would eat up my deductible, so they didn't require anything up front. I gave the hospital $3,000 up front.

Call your surgeon's office then call the hospital and ask them.

They did explain during my initial consult, but it was a bit overwhelming taking in all of that information. Thank you for your response. I will definitely follow up with my insurance

I don't think the OP is coming back...

@@Sarah 82 I have UHC and still uncertain on what they're looking for in the 6 month supervised diet plan. Do they want us to lose? Will we be penalized if we do? I dropped below my BMI of 41 to a 39 for one month but was back up by the next month. So my starting BMI & ending BMI will still be a 41. I appreciate the offer!!

Sorry this reply took so long! I just started getting notifications for this site. It varies from insurance to insurance but usually whatever your BMI is when the authorization request is submitted is what they will go by.

I have a question for anyone that has had experience with Carefirst BCBS. I am currently enrolled in a PPO plan. The doctor that I am using is out of network. My in network and out of network deductibles ( oon deductible is $3200) will not be combined. If I don't meet my out of network by deductible by the time I am due to have surgery, will I be responsible for paying the surgeon the $3200 upfront? Or how exactly does it work? Any response is welcomed

The amount you should owe will be determined by the facility your surgery is at. You'll have to pay your deductible at the very least but some facilities let you pay half of that upfront and be billed the remainder. It really depends on the policy of that specific facility.