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BC/BS Why are people paying out of pocket ?

Tanette

By Tanette, in Insurance & Financing

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Tanette    69

Tanette
Posted

I have been reading a lot of these post about paying out of pocket or co pays. Why is anyone paying out of pocket of the insurance covers the cost. I would go nuts if I had to pay anything additional to what my co pays have been with all these requirements. Does anyone have BC/BS PPO and live in Maryland ? I would love to know if you had to pay anything extra. I'm all types of confused. Please help me understand.

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The Candidate    3,215

The Candidate
Posted

Some people aren't covered under their particular insurance. Others might do it because they don't want to wait over the long time it can take to fulfill the requirements in order to be approved. And then there are those who are denied after completing the requirements. Getting through the insurance hoops is very much like a shell game. You think you've got it only to discover it's been switched for something else. I had to wait a year to get through mine. I can definitely understand it.

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Tanette    69

Tanette
Posted

Wow. Yeah I've been reading this. I thank god I switched surgeons because had I went with John Hopkins I would have to to start all over again. It took them forever to return calls with questions I had. I went to see the other surgeon and his assistant informed me that BCBS requires 7 months of diet . Smh

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Djmohr    6,965

Djmohr
Posted

Many insurance companies DO NOT cover bariatric surgery. Thankfully when I had my surgery I had United Health Care and never even saw the bill.

Now, I moved states and the annual blood work associated with follow up care is not covered under my insurance because it is considered bariatric follow up. I paid the bill because I did not want it to go to collections. The bill was almost 2300.00.

Just beware, insurance really does matter not only for the surgery itself but for follow up care down the road.

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Loudy227    96

Loudy227
Posted

My friend had only one month left of 6 month diet and her UHC insurance said she could not have her surgery with her chosen facility and surgeon because they moved longer had it as a center of excellence.

Now she has been denied for not having high enough bmi over the last five years.

I have bcbsnc and had no issues, but my friend might have to go the self pay route.

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LisaMergs    2,857

LisaMergs
Posted

My BCBS IL covered everything, minus the $30 copays, including follow up with the NUT (RD).

Starting Oct 1, we switch to United Health Care. Horrid policy!! Heck, they don't even Cover speech therapy for kids unless it is part of another issue (autism spectrum, etc). I'm certain they won't cover my follow up with the surgeon, but I'm 6mos so the next one will be at 1 year, provided no issues in between. Thankfully, my 6 mo check is in the morning, so it's still covered.

I definitely need my husband to have a discussion about what is covered and not for this group

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Marissa.Ann.C    21

Marissa.Ann.C
Posted

From what I've read and the experience with my insurance (anthem BCBS) BCBS seems to be the most pain in the ass company out there to deal with. Making you jump through all kinds of hoops then using any excuse they can to deny if possible.

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Tanette    69

Tanette
Posted

The lady who commented above you said that she has BCBS too and she didn't have any problems . Explain what hoops? What was your starting weight? What did you do for your requirements? Did you do everything asked? What state are you located in?

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LisaMergs    2,857

LisaMergs
Posted

The lady who commented above you said that she has BCBS too and she didn't have any problems . Explain what hoops? What was your starting weight? What did you do for your requirements? Did you do everything asked? What state are you located in?

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Tanette-

The best thing you can do is call BCBS and speak to someone there. The company you work for determines how much of what they will pay for when they negotiate a contract with an insurance company. What one person with BCBS receives for benefits may not be the same for another who works for a different company. It's comparing apples to oranges.

Asking everyone here the specifics of their experience means nothing to your situation. Only what coverage YOU have matters- and that can be found by contacting your provider and insurance company. If I recall, you have not seen the surgeon yet? ( forgive me if I'm mistaken). You need to call BCBS of they are your insurance carrier and then you will have the answers you are looking for today.

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Tanette    69

Tanette
Posted

They cover the surgery full coverage if I meet the requirements. And I do. I was just confused. I honestly thought all BCBS plans were pretty much the same. Thanks anyway guys. She shut the conversation down. Good night

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nurseangel007    7

nurseangel007
Posted

That is correct not all BCBS are the same. I had BCBS and all was covered except my portion to the surgeon which was $400 I work for a hosp that covered the surgery and our plan is that if u have it done at our hospital u pay nothing out of pocket for the hospital bill. It is covered. They didn't even require 6 month diet and exercise journal for the approval. But like the other person said not all BCBC is the same. They vary by employer!

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
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      · 1 reply
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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

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