Hi Dana,

It varies from hospital to hospital.  I had my surgery in March of '09.  My MOOP was $1,800 and I DID NOT have to pay up front, only a small portion of it ($238) to get my surgery schedule.  After surgery, I got billed from various people (hospital, anesthesiologist, etc) and I paid the $1800 after the fact.

All three of my children have also had surgery (in 2010).  They went to the same surgeon, same hospital.  For them, they required the payment IN FULL before they would schedule the surgery.  So their policy changed within a year !  I guess it was because people were not paying their bills after the fact.

You should ask that question Tuesday for sure because the insurance coordinator will be able to tell you!

Good Luck !

Nan 

 

Ok, I've met my deductible of $630 and some of the 20% that goes toward my maximum out of pocket.  So, my MOOP balance is about $3,000.....how does that work?  Will my dr's office require that I pay that up front?  Or will I be billed after surgery?  I'm using Dr. Nick Nicholson, if that helps, and I'll be seeing the ins. person there on Tuesday, but just wanted to have an idea of what to expect when I go!!!  Thanks a bunch!

So on my blog I posted how I started the process here in Hampton Roads on Dec 3. My PCP submitted a referral to the Tidewater Surgical Specialists Group for an evaluation. I attended the seminar and then saw Dr. Gregory Adams who indicated I was a good candidate for Gastric Bypass surgery. I did the all the pre-reqs in late December (Psych, labs), and attended a support group meeting in early Jan. His surgery scheduler gave me tentative date of 21 Feb, and on the 24th she submitted my paperwork to Tricare Prime (North) for the approval for surgery. Today she contacts me and tells me that I was denied. The reason---------- My PCP put the wrong diagnostic code on the original referral. They put an upper respiratory problem instead of morbid obesity. So now I had to contact my PCP and have them resubmit for a new referral with the correct code and hope that it gets approved so that the surgery scheduler can resubmit the surgery paperwork before my tentative date, else I will have to wait until march or april. The kicker, is that Tricare said that there is a good chance that Portsmouth Naval will override the referral and assign me to the Naval hospital for it. And they have a 3 year wait for the surgery. And to make matters worse, all the stuff tricare paid for under the old wrong referral may be taken back, and I would be responsible for everything so far.  So to say the least I am is peaved big time.

I had my 1st app. with my bariatric surgeon last week.  My BMI was 37, and I have 2 comorbidities.  The new 2011 BC/BS requirements state I must have had a BMI of at least 35 for at least 2 years.  My BMI has been between 30 and 33 for most of the previous 2 years. Does anyone know how I might still obtain approval? Thank you!

Thank you!  I spoke with my surgeon's office and they were going to talk with Dr. and for me not to start liver reduction diet yet. 

Thank you for your help!

Lynn