Since new people look or join LBT everyday. Just a reminder that open season was extended for federal government employees might be worth the switch to some looking to have WLS. BS/ BS health insurance basic plan is really good here in Maryland just needed bmi, psych and nut. (of course any evaluations the doctors require) Not sure if it works like that across the country. Just some FYI.

l also have B/C Federal, basic plan...l pay $30.00 co pay for my fills, and now l got a statement from B/C saying l owe the Dr another $175.00 per fill..Appartently the Dr office charges $660.00 for fills and bills it under surgery..lmagine, l'm there in the office, no fluroscope, for about 2 minutes...and its $660.00 dollars....something is seriously wrong with this system..

l also have B/C Federal, basic plan...l pay $30.00 co pay for my fills, and now l got a statement from B/C saying l owe the Dr another $175.00 per fill..Appartently the Dr office charges $660.00 for fills and bills it under surgery..lmagine, l'm there in the office, no fluroscope, for about 2 minutes...and its $660.00 dollars....something is seriously wrong with this system..

Thanks for this information. I have not needed a fill yet. I am going next week and will find out how they bill since fills are done in his office. I pay $20.00 co-pay now so if he bills like yours wow that much for a fill! Yikes!:tt2: I hope I can stay restricted like I am without ever needing a fill

any of you with BC/BS federal standard ever have problems with them paying for the surgery after saying it was approved?

right now they are telling me i'm approved, it will be $300 for hospital, and 15% up to $5,000 (which it shouldn't be anywhere near that) then it's 100% covered.

BUT...i know when they approved shots for my premature baby 2 years ago to have RSV shots that where CRAZY expensive, AFTER the 6 months/6 shots were given, BC/BS took the money BACK from the pharmacy the shots were from, and told US we owed them the money.....at the sum of $24,000!!! for SIX shots!

we fought the charges, did the appeal, they still denied paying it, then we went throught the next step before they FINALLY decided to cover it!

i have this little fear in my head of this happening...not enough to make me cancel my BAND date of 3/3/09 though! LOL

it will be worth every penny if we ended up paying for it, but i was wondering if any of you had to fight to have it paid after getting a pre-certification approval?

thanks!

right now they are telling me i'm approved, it will be $300 for hospital, and 15% up to $5,000 (which it shouldn't be anywhere near that) then it's 100% covered.

I had a deduction of $300.00 which they have already applied to my surgeon's bill. I do not know about the hospital part yet because the hospital has not billed them. But I do know that I will pay $200.00 for a copayment. I had emergency surgery in December and only paid the copayment at that time too.

What is the 15% for? I am not aware of the 15% for the hospital also. There is nothing mentioned about this in my benefit plan brochure and I have standard also. I know my I am responsible for 15% of the plan allowance for my surgeon, the anesthesia, and the radiology. You only pay 15% of what the plan pays them.

For example here's my surgeon:

Billed Amount: $3,750.00

Covered Charge Amount: $3,750.00

Medicare / Other Ins.: $0.00

Deductible Amount: $300.00

Coinsurance Amount: $110.83

Co-payment Amount: $0.00

Amount Paid: $628.09

What You Owe This Provider: $410.83

Edited February 21, 200917 yr by bklyn1984

sure like to know wha this looks like in 2011 with basic.. like nobody really talks about it,

sure like to know wha this looks like in 2011 with basic.. like nobody really talks about it,

You mean 2012? www.opm.gov/insure

http://www.opm.gov/i...ures/71-005.pdf is a link to their brochure.

Basic:

Preferred: $150 copayment per performing surgeon

Note: If you receive the services of a co-surgeon, you pay a second $150 copayment for those services. No additional copayment applies to the services of assistant surgeons.

Note: You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 128 for more information about "agents.")

Participating/Non-participating: You pay all charges

Note: Prior

Gastric restrictive procedures, gastric malabsorptive procedures, and combination restrictive and malabsorptive procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with one or more co-morbidities; eligible members must be age 18 or over

Note: Benefits for the surgical treatment of morbid obesity are subject to the requirements listed on page 54.

Preferred: 15% of the Plan allowance

Participating: 35% of the Plan allowance

Non-participating: 35% of the Plan allowance, plus any difference between our allowance and the billed amount

Note: You may request prior approval and receive specific benefit information in advance for surgeries to be performed by Non-participating physicians when the charge for the surgery will be $5,000 or more. See page 17 for more information.

Preferred: $150 copayment per performing surgeon

Note: If you receive the services of a co-surgeon, you pay a second $150 copayment for those services. No additional copayment applies to the services of assistant surgeons.

Note: You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 128 for more information about "agents.")

Participating/Non-participating: You pay all charges

Note: Prior approval is required for outpatient surgery for morbid obesity. For more information about prior approval, please refer to page 15.

• Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. The member must meet all requirements.

- Diagnosis of morbid obesity (as defined on page 53) for a period of 2 years prior to surgery

- Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 35 for our coverage of nutritional counseling services.)

- Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise

- Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective

- Psychological clearance of the member’s ability to understand and adhere to the pre- and post-operative program, based on a psychological assessment performed by a licensed professional mental health practitioner (see page 86 for our payment levels for mental health services)

- Member has not smoked in the 6 months prior to surgery

- Member has not been treated for substance abuse for 1 year prior to surgery and there is no evidence of substance abuse during the 1-year period prior to surgery

I got the info from the ins co, just dont know if Ineed money day of pre-op (19th)or the day of surgery, and if it's the $75 for outpatient and $150 for surgeon, or what else? I called hospital, she said the ins coord would call me sooner to surgery. That is one more paycheck away. I just dumped $1800 on a transmission, so trying to see all options. If I am billed for the 30% stuff I'll be OK.

I have FEP Blue and I was approved literally in 24 hours. I was stunned...so was my surgeon's office. My surgery copay was $150. It is my understanding with the office that the fill co-pays will be $35. Even if it was $100 each time, it is a whole lot less than paying for the entire surgery out of pocket.

Jen

_{Did you pay that at hospital, do you rem? I just want to make sure I have what I need the day of surgery. or for the pre-op}

_{Oh yea the fills, I didn't think they be much... I am very happy with FEPBLUE right now}

With the basic plan, do you have to pay 30% of the band?

With standard or basic, does anyone know what happens if band has to be removed for whatever reason, will they pay to have a second band placed?

Thanks in advance,

Melinda

With the basic plan, do you have to pay 30% of the band?

With standard or basic, does anyone know what happens if band has to be removed for whatever reason, will they pay to have a second band placed?

Thanks in advance,

Melinda

Thats some great information! we should have our own forum!. I am preparing with $75 outpatient fee and $150 for the surgeon. The rest hopefully is billed. I do know different states and doctors have different fees and requirements. I pushed to be done before 12/31 as my CO- insurance is about $1600 already- so Id owed about $3400 max. Why do you have to go to same Dr for fills? I saw one Dr. here filling for $40 and Mexican banders go to him and he is in a BIG gen hospital, so any reason to have to stay there? I was also told by FEPBLU that they pay for band removal if they have it take it out. Not sure if they will replace or you have to wait again.

Thats some great information! we should have our own forum!. I am preparing with $75 outpatient fee and $150 for the surgeon. The rest hopefully is billed. I do know different states and doctors have different fees and requirements. I pushed to be done before 12/31 as my CO- insurance is about $1600 already- so Id owed about $3400 max. Why do you have to go to same Dr for fills? I saw one Dr. here filling for $40 and Mexican banders go to him and he is in a BIG gen hospital, so any reason to have to stay there? I was also told by FEPBLU that they pay for band removal if they have it take it out. Not sure if they will replace or you have to wait again.

Grider, sorry I misunderstood your question. I have bcbs *** so cannot answer specifically, but my hospital co-pay was due when I did my pre-admission stuff a few days before surgey. They would not proceed without payment. That was my experience, you might be able to work something out in advance.

Melinda, look at the brochure link I posted, it speaks of a second surgery. Insurance companies will pay for band removal if medically necessary. I am not sure about paying for a new band. Sorry I am of little help on that question.

Grider, just guessing, but I'd think the 30% would be billed, they have no idea how much of what things they will use until after the surgery is over. At least, that's the way my pea brain sees it.