BCBS Co-insurance Questions

momma_missie
on 6/21/15 7:54 pm - Indian River, MI

I've asked similar questions before and not got much of a response, so going to try to be a little more clear this time in hopes others have similar experiences and could share their stories. 

 

I have BCBS of Michigan. I am covered under my employer and I have  50% co-insurance coverage. My out of pocket co-insurance maximum should be $3000 according to my plan documents. My out of pocket max for healthcare period should be $6,600, this includes my co-insurance payments according to my plan documents.

 

I have done my psych eval, surgical consult, etc. and the hospital should be submitting for approval for the procedure this upcoming week. However, the lady who is in charge of getting approval for the surgery made a comment about how co-insurance and out of pocket maximums don't usually apply to bariatric surgery and that I would likely be spending $15,000-$20,0000 out of pocket in order to have the procedure. She couldn't give details because she wasn't from the financial department, but she told me that I'd be in touch with someone from financial to figure out what costs I'd be responsible for once she gets me approved for the surgery. 

 

I was heartbroken and have been in a bad mood ever since. I'm sick with worry, fear, anxiety, etc. I want and need this surgery more than I'd been willing to admit until recently. I was every bit prepared to pay $6000 - $7000 out of pocket. It's a small price to pay. Just wondering if others had co-insurance amounts they had to pay and if bariatrics were included or excluded. Thanks in advance!

hollykim
on 6/22/15 2:28 pm - Nashville, TN
Revision on 03/18/15
On June 21, 2015 at 7:54 PM Pacific Time, momma_missie wrote:

I've asked similar questions before and not got much of a response, so going to try to be a little more clear this time in hopes others have similar experiences and could share their stories. 

 

I have BCBS of Michigan. I am covered under my employer and I have  50% co-insurance coverage. My out of pocket co-insurance maximum should be $3000 according to my plan documents. My out of pocket max for healthcare period should be $6,600, this includes my co-insurance payments according to my plan documents.

 

I have done my psych eval, surgical consult, etc. and the hospital should be submitting for approval for the procedure this upcoming week. However, the lady who is in charge of getting approval for the surgery made a comment about how co-insurance and out of pocket maximums don't usually apply to bariatric surgery and that I would likely be spending $15,000-$20,0000 out of pocket in order to have the procedure. She couldn't give details because she wasn't from the financial department, but she told me that I'd be in touch with someone from financial to figure out what costs I'd be responsible for once she gets me approved for the surgery. 

 

I was heartbroken and have been in a bad mood ever since. I'm sick with worry, fear, anxiety, etc. I want and need this surgery more than I'd been willing to admit until recently. I was every bit prepared to pay $6000 - $7000 out of pocket. It's a small price to pay. Just wondering if others had co-insurance amounts they had to pay and if bariatrics were included or excluded. Thanks in advance!

are you sure your employer has bought bariatric coverage for its employees? Co insurance and deductibles certainly apply toward bariatric surgery,IF,IF your employer had bought the coverage. If the employer has not bought the coverage,then it is considered an excluded procedure and it sounds like to me,the 15-20,000 figure you were quoted is the whole cost of the surgery. You would,essentially,be a self pay patient.

 


          

 

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