Today is a good day! 

Beth from DukeWLS let me know that my information has been submitted to my insurance carrier for their review/approval. 

I wanted to know what my financial responsibilities would be before I get there … at least as much as possible. I wanted to know what the worst case scenario would be. So before I called the insurance, I called DukeWLS and spoke with Beth … she handles the insurance submissions for Duke Weight Loss Center. She was really very helpful and gave me pretty much "word for word" the information/questions I needed to get the coverage information I wanted to get from my insurance carrier. It is so much easier to deal with them when you know the right information to give them when they are looking up your providers and the right questions to ask to ascertain what your liability will likely be. Of course, you will have different coverage, but I think the information that Beth gave me would work for just about anyone who wants to be sure that you are getting the correct information from your insurance carrier. I hope that this will be as helpful to you as it was to me! (Thanks Beth!)

This is the information I provided my insurance carrier to get a straight answer about what they pay and what my responsibilities would be:

1. Call the insurance carrier’s medical benefits customer service department.
2. Obtain the name (first, last), ID number and location of the customer service representative.
3. Document the date and time of your call.
4. Tell the customer service representative that you need to determine coverage for inpatient surgical services.
5. Provide the customer service representative with the tax ID # for your doctor and/or his surgical office. This is a unique identifier and should reduce confusion about which Dr/Practice your are getting information about.
   1. Ask the customer service representative if the provider is in network or out of network?
   2. Ask the customer service representative for the dollar amount or percentage of your co-pay?
   3. Ask the customer services representative to tell you the co-pay dollar amount or percentage you will be responsible to pay for surgical services, if billed separately? If the Dr. has a different tax ID number than the hospital, the Dr's surgical fees are billed probably billed separately.  
6. Provide the customer service representative with the tax ID # for the hospital your doctor uses
   1. Ask the customer service representative if the hospital is in network or out of network?
   2. Ask the customer service representative if there is a dollar amount or percentage co-pay for inpatient services?
   3. Ask the customer service representative to list what they define as inpatient services? Different insurance companies might define what they pay for with "in-patient" services differently depending on the policy you have and any limitations or exclusions that might be a part of your particular policy.  

Armed with the tax ID information that Beth, the insurance specialist, provided and the questions she told me to ask, I contacted my health insurance carrier to see if I could finally get some clarification on my surgical expenses. 

Eureka ! With the right information and questions, I got the answers I needed. The only real unknown for me, is what the insurance considers “reasonable and customary” fees. Everyone has different clauses in their insurance so, I'm sure mine is somewhat different than others, but just to give you an idea of what I'll have to pay .... I’ll have fixed co-pay for the hospital and a percentage co-pay for the surgeon’s fees. I also have a maximum total out-of-pocket dollar on what I have to pay. Once I hit that ceiling, my insurance covers @ 100% of the “reasonable and customary” fees. You have to be careful with that. It doesn’t necessarily mean that the insurance will cover 100% of the bill, so you may be left with any additional amount above what the insurance considers “reasonable and customary.”

Once my package was submitted to the insurance I called to be sure that they had everything. Then left it alone for a about a week. After that, I called twice a day. Each time I called I asked for the Care Coordination office. Wrote down the Date, Time, Who I spoke with and their location. I got that info before I gave them my information, so that I'd get it all down.