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Topic: Help with insurance lingo
Hello all!
I am interested in having gastric bypass surgery, but I am confused with the way my insurance works. My hubby's insurance has recently changed, and now our deductible is $10,000! Well the good thing is that it does cover weight loss sugery. My question is this (and I'm sure it may be a stupid question): When will I have to pay this, and who do I pay? Is this an amount that I will have to pay BCBS, the hospital, or my surgeon? Can I be billed this amount after surgery, because I don't have this kind of money. I'm so completely loss. Any and all answers will be greatly appreciated, but please explain it to me like i"m a 2 yr. old, lol.
Thanks!!!
I am interested in having gastric bypass surgery, but I am confused with the way my insurance works. My hubby's insurance has recently changed, and now our deductible is $10,000! Well the good thing is that it does cover weight loss sugery. My question is this (and I'm sure it may be a stupid question): When will I have to pay this, and who do I pay? Is this an amount that I will have to pay BCBS, the hospital, or my surgeon? Can I be billed this amount after surgery, because I don't have this kind of money. I'm so completely loss. Any and all answers will be greatly appreciated, but please explain it to me like i"m a 2 yr. old, lol.
Thanks!!!
Topic: RE: Tricare Prime North question
I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
I'm sorry, TriCare and Medicaid are the two ins co's where appeals do no good. :o(
On January 15, 2011 at 10:49 PM Pacific Time, wynter57 wrote:
Hello there. I've seen many of your post advocating DS surgery. I've read a lot of good things about it and I was considering having the DS. I'd be a revision FROM a VBG done 22 years ago. Anyway, like Jess said, TriCare does not cover the DS.I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: Tricare Prime North question
Hello there. I've seen many of your post advocating DS surgery. I've read a lot of good things about it and I was considering having the DS. I'd be a revision FROM a VBG done 22 years ago. Anyway, like Jess said, TriCare does not cover the DS.
I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
I did not know there was any way to appeal a surgery choice. Have you heard of Tricare Prime insurance letting someone who appealed the RNY choice to a DS?
The doctor I am thinking about does the DS but they said he only does it if you are 600 pounds or over and thank God, I don't qualify for that weight.
If you have information as to how to appeal Tricare Prime and have them approve a DS, please advise.
Also, I was told a couple of years ago via an endoscopy that I had a duodenal ulcer. Not sure if that would mean anything as far as getting a DS?
Thanks for your help and advice.
Topic: RE: upfront cost bcbs trs activecare 2???
Your policy likely changes a bit from year to year so it's hard telling if you are comparing to your coworker. Also, someone else may have the same ins as you but through a different employer so the policy would again be different.
There is really no way to tell you your up front fees because you'll likely have a program fee through your surgeon that ins will not cover.
There is really no way to tell you your up front fees because you'll likely have a program fee through your surgeon that ins will not cover.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: UNITED HEALTHCARE PPO 90 PLAN???!!!
It's a group policy so you shouldn't have to deal with pre existing conditions. Go for it!
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: UNITED HEALTHCARE PPO 90 PLAN???!!!
hey everyone i have a question regarding to united healthcare ive been in my job for about 2 years this past october i joined there health insurence and it has been active since jan 1. is it ok to submit a claim for bariatic surgery to uhc already or should i wait it a bit more, i have called and got informed that they do cover the surgery under the plan offered by my job. ANY SUGGESTION ARE WELCOMED THANK YOU ALL, gissel
Topic: upfront cost bcbs trs activecare 2???
hello!
i live in texas and have bcbs thru trs activecare 2. i have a coworker that had gastric back in nov 09 and i'm wondering how much are the upfront fees? is it jus the $500 deductible? i've looked at all the req for the ins and i met all of them but i can't find anything clear about the cost.
jana
i live in texas and have bcbs thru trs activecare 2. i have a coworker that had gastric back in nov 09 and i'm wondering how much are the upfront fees? is it jus the $500 deductible? i've looked at all the req for the ins and i met all of them but i can't find anything clear about the cost.
jana
Topic: RE: Does ins pay for revision
It all depends on the plan your company has with the insurance company. When I had my band done back in 2007 I had UHC and my company's plan had no coverage for WLS so I paid out of pocket. I needed a revision 3 years later and fortunately my current company's plan with UHC covered WLS and revisions. Thank God. In my case I had UHC at 2 different companies but each company selected different types of coverage.
You really must review your SPD (Summary Plan Description) and talk with your insurance company.
Good Luck!
You really must review your SPD (Summary Plan Description) and talk with your insurance company.
Good Luck!
HW:330, SW: 280, CW: 161, GW: 165 
Topic: RE: do any one in Ga have UHC choice plus and know RYN is covered
Call your insurance company directly and find out if bariatric surgery is covered under your specific plan. I called my insurance company before going to a Surgical Weight Loss seminar to find out if the surgery was covered. In addition asks if they have a required program to follow for eligibilty and the types of surgery that are covered. Also ask if they cover nutrition visits and ask for a copy of your member benefits to be sent to you so that you can read and study exactly what they cover and do not cover.
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