the problem i am having is getting any kind of information on what my co pay is going to be. I have to deal with Desert Oasis, they are the medical group that i have to go through, but they tell me i have to talk to my insurance company to find out what the co pay is, blue cross says its up to desert oasis, but they still say its too early in the process to know. They cant seem to understand that i have to save up the money for this and try to get some of it covered by flex dollars etc. my question is, has anyone had to use either desert oasis or blue cross in southern california? I just need some type of figure to work towards. Im getting so frustrated. If i have to wait till the last minute to find out what i have to pay, i wont be able to get it.

Hi there,

I just got approved through Anthem BC So Cal. First off do you have an HMO or a PPO? HMO with anthem is going to be a lot more difficult to get approved than the PPO, with the PPO if your BMI is over 40 it's pretty much a slam dunk. Next there should be a number on your medical ID card for customer service or benefits. They are correct in telling you that they won't know EXACTLY how much you will have to pay. However they can tell you what your plan provides for. Ask them what your MAX annual out of pocket expense is for your plan. Ask your medical group if they have a "program fee" that they charge for services insurance does not cover, (mine did). You will be getting bills from different people for different things, testing, doctor, hospital so forth. The best thing to do is to find out what your MAX out of pocket expense for a year is. If you have a PPO and you or anyone in your family has incurred medical expenses this year already you can ask them how much has been applied to your out of pocket expense so far this year.

The best thing to do is to budget for the combined total of what your MAX out of pocket expense is plus any program fee the medical group you are using will have.

Just to give you an example: If your max out of pocket expense for the year on your plan is $3000.00 and you have not incurred any medical expenses this year at all then plan for $3000 plus any program fee. If you have incurred medical expenses this year for any reason and you have paid say $500 out of pocket so far, then plan for $2500 plus any program fee.

I hope this helped you out a bit. Customer Care at Anthem should be able to tell you what your max out of pocket is and how much you have incurred so far this year!!

GOOD LUCK!!!!!! let me know if this helped at all.

my insurance is hmo and bmi is 50. I did call customer service and he said he couldn't give me any information because Desert Oasis used an out of net doctor. I hate this stuff, it just freaking confuses me. I've had to fight every step of the way to get anything done. **sigh** well now that I have had my temper tantrum...i will try making some more phone calls. Thanks for your help Laya.

Edited April 15, 200917 yr by DesertMommas

the problem i am having is getting any kind of information on what my co pay is going to be. I have to deal with Desert Oasis, they are the medical group that i have to go through, but they tell me i have to talk to my insurance company to find out what the co pay is, blue cross says its up to desert oasis, but they still say its too early in the process to know. They cant seem to understand that i have to save up the money for this and try to get some of it covered by flex dollars etc. my question is, has anyone had to use either desert oasis or blue cross in southern california? I just need some type of figure to work towards. Im getting so frustrated. If i have to wait till the last minute to find out what i have to pay, i wont be able to get it.

I have Anthem Blue Cross in So Cal myself,and I had a ZERO copayment for my surgery. What you want to do is look at your benefits book also your Evidence of Coverage book the fact that they are going out of network is on your medical group not you. You have no say in that matter. Under Inpatient hospitilization would list your copay amount. The ony other thing you can do is call Anthem and state if i go to the ER and get admitted do I have a copayment for that admission? That should be your answer. Now the twist could be if you are having your surgery on an Outpatient basis, then you'd want to ask about that. Even if you tell them you are having an op surgery like carpal tunnel release the copay should be the same. You are on an HMO so there is laws protecting you from Balance Billing and paying a higher copay for going out of network, cuz again if your medical group is approving it out of network then you are ony liable to pay as if it is in network. I work at a major IPA in the Inland Empire so I deal with this stuff on a daily basis.

I have Anthem Blue Cross in So Cal myself,and I had a ZERO copayment for my surgery. What you want to do is look at your benefits book also your Evidence of Coverage book the fact that they are going out of network is on your medical group not you. You have no say in that matter. Under Inpatient hospitilization would list your copay amount. The ony other thing you can do is call Anthem and state if i go to the ER and get admitted do I have a copayment for that admission? That should be your answer. Now the twist could be if you are having your surgery on an Outpatient basis, then you'd want to ask about that. Even if you tell them you are having an op surgery like carpal tunnel release the copay should be the same. You are on an HMO so there is laws protecting you from Balance Billing and paying a higher copay for going out of network, cuz again if your medical group is approving it out of network then you are ony liable to pay as if it is in network. I work at a major IPA in the Inland Empire so I deal with this stuff on a daily basis.

I actually just talked to very nice lady at Anthem who went all through my policy and explained everything to me. I have zero copay ( i told her that i loved her) and the doctor i chose is fine because as you say, my medical group contracts him. She also told me it doesn't matter if it is inpatient or outpatient, i have no copay on either. YAY!! Thank you God!! and thank you for all your help Laya and Busybee!!

Edited April 16, 200917 yr by DesertMommas

Good luck to you!!! A friend had HMO and it gave her hell too, keep up the good fight and good things will come!!!

Laya

Okay so how do you find a doctor in-network??? I have been getting quoted that out of pocket expenses will be between 4500-6000 from different people. I live in Orange county and am looking for a GOOD doctor who will not gauge me for out of pocket expenses and pretty much just take what my insurance is willing to give. I have a PPO Anthem Blue Cross. Thanks!@

My doctor just referred me. What is the process like? I've read about Kaiser doe Anthem BC operate in the same manner. I have HMO at Loma Linda Medical group. Thank you.

I went to a consultation and set up a surgery date all in one day. I was then called by the office and was told that it was not covered. I have Anthem Blue Cross HMO and I live in SoCal and they were not "in-network" and they told me I have to find an "in-network" surgeon. I tried to contact Anthem but I have had no luck with them so far. It is really frustrating that no one can give me an answer.

I went to a consultation and set up a surgery date all in one day. I was then called by the office and was told that it was not covered. I have Anthem Blue Cross HMO and I live in SoCal and they were not "in-network" and they told me I have to find an "in-network" surgeon. I tried to contact Anthem but I have had no luck with them so far. It is really frustrating that no one can give me an answer.

If you have an HMO you need your pcp to refer you to a bariatric surgeon. Once you have the referral you can see the surgeon and discuss what other preops they have. I had surgery at Cedars sinai with blue cross anthem HMO. and i had a bmi of 40.1 with no comorbidities it can be done

Hello! I have a quick question, I am trying to find a doctor who is in the anthem blue cross network. I haven't had the luck to find a doctor within the network. Any recommendations for biartic doctors in southern california? thank you!

DesertMammas: Where in So Cal are you? I'm near palm springs and have BC/BS. My co-pay is 10%

I am trying to figure out if my Blue Cross of California *** 10/100 is going to cover the lap band for my husband and I. We both went to our PCP requesting the lapband. My husband would be considered morbid obese (not sure of his BMI) and my BMI is 35.44. We both have high blood pressure with long family history of obesity and diabetes in our family (parents & sibblings). We each received an authorization to attend the required 6 months of dietitian classes. I understand it is a requirement prior to having any weight loss procesure to attend the 6 month classes and a siminar on lapband/gastric bypass as well as psych exam. I'm just not real real clear if getting the authorization for the dietitian means we will each get the authorization approved for the surgery once completed all requirements. It seems by what I have read on this site, my husband will be approved as he has a much higher MBI.... not sure on myself. Has anyone received approval with BMI of 35.44 with one comorbidities.

Really hoping for some help here... thanks

Hi there,

I just got approved through Anthem BC So Cal. First off do you have an *** or a PPO? *** with anthem is going to be a lot more difficult to get approved than the PPO, with the PPO if your BMI is over 40 it's pretty much a slam dunk. Next there should be a number on your medical ID card for customer service or benefits. They are correct in telling you that they won't know EXACTLY how much you will have to pay. However they can tell you what your plan provides for. Ask them what your MAX annual out of pocket expense is for your plan. Ask your medical group if they have a "program fee" that they charge for services insurance does not cover, (mine did). You will be getting bills from different people for different things, testing, doctor, hospital so forth. The best thing to do is to find out what your MAX out of pocket expense for a year is. If you have a PPO and you or anyone in your family has incurred medical expenses this year already you can ask them how much has been applied to your out of pocket expense so far this year.

The best thing to do is to budget for the combined total of what your MAX out of pocket expense is plus any program fee the medical group you are using will have.

Just to give you an example: If your max out of pocket expense for the year on your plan is $3000.00 and you have not incurred any medical expenses this year at all then plan for $3000 plus any program fee. If you have incurred medical expenses this year for any reason and you have paid say $500 out of pocket so far, then plan for $2500 plus any program fee.

I hope this helped you out a bit. Customer Care at Anthem should be able to tell you what your max out of pocket is and how much you have incurred so far this year!!

GOOD LUCK!!!!!! let me know if this helped at all.