My doc submitted to insurance on Thursday, they called and gave approval today!!! That's two business days!!! YAHOOOOOOOOOOOOO! My out of pocket- $3,750.... =( I was originally told it would be $2,000. So now I had to schedule surgery for Jan 22nd so I can save up the extra $1750. Ugh....

Do they make you pay all of it upfront? I called my B/C B/S PPO and they did say I had a $1500 dec and they cover 75% and I asked them if I had to pay that upfront and they said it was up to the hospital and doctors. I have been worried about that part.

My doc submitted to insurance on Thursday, they called and gave approval today!!! That's two business days!!! YAHOOOOOOOOOOOOO!

I am so happy for you! I am glad that you are off of the waiting for approval roller coaster! I am sorry that you have to wait, but January will be here before you know it.:grouphug:

I saw that you were approved in only 2 days to get the Lap Band surgery. I'm considering getting this procedure and I was trying to choose an insurance carrier for my family that would also allow me to do this.

Would it be possible for you to share with me the process of getting approved by them?

This is my first post on this board and I just have to say the my insurance approved me on less than one day! I am so excited that I can hardly stand it. :tt1::biggrin::tt1:

I just noticed the questions, I'm sorry I didn't respond sooner!!

Yes, my doctor requires me to pay everything up front. Radar, I replied to the message you sent me. =)

I have Anthem Blue Cross too...this is good news for me. I am awaiting approval now. Just went for the consult yesterday. I am hoping that my out-of-pocket expense will be do-able for me.

I have Anthem Blue Cross too...this is good news for me. I am awaiting approval now. Just went for the consult yesterday. I am hoping that my out-of-pocket expense will be do-able for me.

have you been approved??

I never got that far.....the surgeon's office called me and told me Anthem will only cover $7500, and if they bill it through the insurance it will be $32,000 and that I could end up with $20,000 or more out of pocket. Then they told me I should just self-pay the $13,000 and do it that way ---There's no way I can come up with that right now (yeah, I've got $13,000 just laying around...NOT!). I am totally bummed! :cry_smile:

They DID say it should be no problem to get the approval from my insurance though (even though it will do me no good). So I just got $1300 worth of lab work done for nothing!

I guess I'm gonna have to try to lose the weight on my own once again. I cried at first, but now I am resolved to it and trying to keep a positive outlook and stay motivated. After spending Christmas with my mom and seeing what years of being overweight has done to her body, I know I need to get this weight off before it destroys me too. Wish me luck.

To all those out there who have insurance companies that will cover the real cost of the surgery, you are VERY lucky, and I wish you all the best.

Wow why so much out of pocket? I have BC BS of CA and that is not even close! Who gave you that figure? BC or doc's office. I too was approved after 2 days...I was overjoyed! Good thing about that much out of pocket is that you can claim that entire amount on your taxes next year. K

Blue Bug I can't believe how much BC BS varies from state to state! That is bittersweet, yea they will cover you, but yuck you have to pay the bulk of the procedure.

Edited January 11, 200917 yr by kfgates

The surgeon's office gave me the figure of $20,000 out of pocket with insurance. She explained it like this: If they bill the insurance, it costs way more because they have negotiated rates with the insurance companies, and everything has to run its course through billing, etc. and that they may wait up to 6 months to get paid.....whereas if I pay up front the surgeon and the hospital give me a huge discount because they get their money right away! - I know, not a good scenario.:thumbdown:

I guess if they bill the insurance, it costs something like $32,000.

Anyway, good luck to you. I'm glad your insurance will pay more.:wub:

I have Anthem BC CA had surgery recently luckily my out of pocket is only $1000, + $250 deductable AND 10% CO PAY I owe the hosp $600, put had to pay 10% before admission which was about $300 so should only owe about $300. My group ha a program fee for after surgery which was $3500 and had to pay that up front not covered by BC so toatl cost of lapband to me about $4800

I'm happy for you but... I jumped the gun and had the surgery done in Mexico before getting the final word from my insurance. (I'm blue cross anthem too) well, 2 days after getting back from mexico I got the email that I was approved for surgery. Now I will be paying a cool $4K extra for the procedure and aftercare/fills. Of course I did my consult in mid Nov and only got the word this morning. If my approval had happened in two days I could've saved a lot of money.

Word to the wise, dont' jump the gun. wait for you insurance company to give final word before you go self-pay. :-( at least I had the money and surgery is done, but I could've used the savings during these tight times. Hopefully they'll agree to pay a significant portion of my aftercare.

Blue Bug I would consider calling your insurance carrier to make sure the figure from the surgeon's office is correct (it sounds a little fishy to me) and if it is correct I would find another physician if I were you. Don't give up hope:rolleyes:

I never got that far.....the surgeon's office called me and told me Anthem will only cover $7500, and if they bill it through the insurance it will be $32,000 and that I could end up with $20,000 or more out of pocket. Then they told me I should just self-pay the $13,000 and do it that way ---There's no way I can come up with that right now (yeah, I've got $13,000 just laying around...NOT!). I am totally bummed! :ohmy:

They DID say it should be no problem to get the approval from my insurance though (even though it will do me no good). So I just got $1300 worth of lab work done for nothing!

I guess I'm gonna have to try to lose the weight on my own once again. :laugh: I cried at first, but now I am resolved to it and trying to keep a positive outlook and stay motivated. After spending Christmas with my mom and seeing what years of being overweight has done to her body, I know I need to get this weight off before it destroys me too. Wish me luck.

To all those out there who have insurance companies that will cover the real cost of the surgery, you are VERY lucky, and I wish you all the best.

Is your provider participating in the BlueCross Network? If so they cannot balance bill you for the difference. They sign a contract with BlueCross/Anthem that they will accept what insurance pays. You should only be responsible for your deductible and any co-pay / co-insurance.

Crystal (Nurse Reviewer for an insurance company)

Blue Bug, a lot of health insurance companies have a maximum out of pocket amount you would be obligated to pay in a year. Check your policy!