Question:
Out-of-Pocket Costs with BC/BS Federal Plan

I have BC/BS Federal Plan. I would like to hear from others as to how much you had to pay out-of-pocket. Gastric Bypass is listed as a covered procedure in their insurance manual, and BC/BS will not precertify surgery or payment. I have seen a surgeon at BTC and had a psych evaluation. BTC has an insurance review panel that will review all of my documentation. I am still concerned though as to how much this will cost me financially. What if I have the surgery and, God forbid, my insurance covers nothing! If anyone has had this surgery with BC/BS Federal, please let me know what your costs were. Thanks. Paulette    — Paulette W. (posted on September 7, 2001)

September 7, 2001
Paulette - look at your insurance policy and try to find the section that refers to out-of-pocket expenses. The majority of policies have a maximum that you have to pay, meaning, when your out-of-pocket reaches a certain amount, then your insurer pays 100% of the balance. In my case, my policy has a maximum $1500/yr o.o.p. I'm going to BTC too, so if my balance is $5000, I only have to pay $1500 of that, and my insurer picks up the rest. All policies are different, but the majority of them are structured this way.
   — scottiemaam O.

September 7, 2001
i have fed bc/bs. my understanding is that as long as i use a bc provider my pocket expense is nothing. same for the hospital. by the way, my surgeon has rec'd pre-certification from bc & it took less than 48 hours from the time of submission.
   — sheryl titone

September 7, 2001
I have BC/BS Federal Employee Plan.....I had my Open VBG on June 11, 2001 (down 72lbs as of today!!) - my total hospital charges were about $35,000, and I had to pay $129.00 (because I had a private room). That's all - it paid 100% of the Surgeon, Anesthesiologist, Lab costs, etc...I didn't have to have a Psych consult and all of that pre-stuff....just a chest xray, gallbladder sonogram, blood work.
   — Cathy J.

September 8, 2001
Hi Paulette. Wish I had known about this site before I started. They tell you they don't precert, but they do! They can make it very confusing. Call customer service and make them fax a copy of the requirements for your plan to him. This will save a lot of time. They will only send it to the MD. They don't really precert the surgery they precert the hospital stay. But you do the same thing. I have Federal B/C B/S Service Benefit Plan. Postal. I have heard it is really not too difficult, I do have to have a psychology eval, T3T4Tsh and Diet History of about 18mos. If I had known all this when I started it would have been easier. Now, my date is 10/8 and I haven't been precerted yet and am still getting my stuff together. So the moral of the story is, Find out what you need first! You may have to speak to a supervisor to get the info you need from the ins co. Good Luck Linda
   — Linda B.

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