BMI 39-bcbs of north carolina

Thread Starter

Thanks. I would really appreciate that.

Hi, I'm getting banded on 8/11 and have BCBSNC. My BMI is 39 and I have no pre-existing medical problems. BCBSNc approved me with no problems, don't know if the staff @ my doctors office pushed it or if the insurance just approved it, but either way, I'm approved!!!!!!

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Seminar Date: 5/5/09
Initial Assessment: 6/26/09
Psych Eval: 6/17/09
Nutritional Eval: 6/17/09
Pre-Op w/i Surgeon: 8/7/09
Surgery Date: 8/11/09

Thread Starter

Good for you. I'm glad to hear that, maybe I still have hope. I'm just waiting on the approval from the insurance company. Being that our plan changed on July 1st, do you know if you have to pay the deductible up front? And who are you going through to get your surgery done?

The new year started over July 1st, therefore, if you haven't met your deductible you must do so. If iI would have had the surgery prior to July 1st, I wouldn't have to had pay anything, b/c I had met my deductible.

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Initial Consult 5/12/09 Barium Swallow 5/15/09
Pshy Evual. 5/20/09 Sleep Study 5/21/09
#1 Nutrition Evual. 5/21/09
#2 Nutrition Evual. 6/25/09 #2 Consult 6/24/09
Approved 7/1/09 Surgery Date 7/31/09


Nothing tastes as good as being thin feels.

I haven't been on here in a while. But I finally had my surgery 07/01. So far I've lost 15lbs. I didn't pay anything upfront, but that is because I refused. Since I work for Bcbsnc I know that if you go to a provider that is Inn network then you're not required to pay upfront and alot of people don't know that so they pay their deduct upfront. When your ded starts over depends on what policy you have, I work in the state health plan department and their ded started over 07/01/09, but my policy won't start over until 01/01/2010. So call and see if you're on a fiscal year or calendar year. I've starting receiving bills my surgery total was $36,642 and my part is $3500 which isn't bad. I get my first fill 08/04 and I'm ready Since my swelling has gone down quite a bit I'm starting to get really hungry

Thread Starter

Congrats to you. I know I'm on Fiscal and my policy started over on July 1, 09. I'm glad you told me that I'm not required to pay my deductible upfront, but can they refuse my surgery if I don't pay upfront? I'm still waiting for BCBS approval, as far as I know, they sent my paperwork to them over a week ago. Just trying to be patient. Thank you so much for your input, it really help rest my anxiety a little. Keep up your good work and please update on your progress.

It really depends on the hospital. I went to Rex in Raleigh and they asked me to pay something towards my ded and I told them that since they are in network that they have a duty to file a claim first and then bill me. If you go somewhere else it's possible that they may refuse service without a payment, but per their contract they are not supposed too.

Thread Starter

I'm going to Duke, I'll just have to wait and see. Thank you for that info.

Who was your doctor, I am consulting with Dr. Moran on today and had my appointment with nutr. on Monday. My physch eval is on tomorrow morning. The last appointment I have is on July 23rd with the cardiologist. I am so close but seem so far away. I am hoping to go to Rex. I do know that some of the doctors use the hospital in Louisburg also.

Thread Starter

My Dr is Sudan out of Duke. I already seen the nutritionist, and had my Psych eval, just waiting on approval from insurance co. Did you read the previous post from FLIPP, she's a bander here and she works for BCBS of NC and said that it's not required to pay the deductible upfront, but depends on what hospital you go to they might refuse surgery if you don't pay. I'm praying they can bill me, I'm really not in a position to pay the deductible upfront right now. I have a daughter who starts college in August and I have to be prepared to assist her. That will be more important than me getting this surgery. Don't get me wrong, this is definitely important, but college comes first.

I completely understand i have just paid $350.00 today. I have had my nutrionist eval, physch eval. On Friday I go for a Barium swallow and need to do blood work and cardiologist appointment of the 23rd. Now that I look at all of this I am hopeful that this does not have to be paid in advance. If anyone knows if this $600.00 deductible has to be paid before the surgery can be done. The next question is who is it suppose to be paid to. Today went well I went for my initial consult today and I end up getting my physch eval done due to a no show. I am now worried because of the deductible. I see where ther is also a 200 out of pocket facility co-pay. I am just confused right now.

I got my call from Dr. Enochs office today. My insurance BCBSNC ( my husband works at wakemed so we use his) is 100% covered with a 50.00 copay. I have to have it done at a WAKEMED facility and it has to be performed by Dr. Enochs, if it isn't it is 90% covered with a 250.00 copay. My consultation is July 28. I am finding that I am talking my self out of this. I am scared of dieing in surgery. I know with my weight he will probably suggest the RNY. I am so torn, and have alot to think about.

Talk to you all later.

Stajin22,
Yes the $600.00 has to be paid before your appointment. I had already met my deductible b/c I had several different doctors appointments throughout the year. If nothing has been applied towards your deductible then it should be paid to the facility performing your surgery. For example: lets say you went to the doctor a month ago for a sore throat, and paid your normal copay, then that bill will be applied towards your deductible. Once you've recieved 600.00 worth of care, then your deductible is met. So for me, I stay @ the doctor for every little thing so thats how I met mine. Good Luck.

__________________
Seminar Date: 5/5/09
Initial Assessment: 6/26/09
Psych Eval: 6/17/09
Nutritional Eval: 6/17/09
Pre-Op w/i Surgeon: 8/7/09
Surgery Date: 8/11/09

It depends on your insurance company. If you have BCBSNC and you go to a doctor that is In-network then they are not supposed to bill you upfront. All doctors or hospitals do not follow the guidelines. I refused to pay upfront and I still had my surgery. If they don't make you pay upfront then you will receive a bill from whatever doctor performed the service. The hospital, surgeon and anesthia are all billed individually, so whatever claim processes first is the one the ded will be applied too and that's the provider that you will pay the $600 to. Also with BCBSNC whenever you go to the doctor and you only pay a co-pay it does not apply to your deductible. I hope this is helpful

I spoke with the insurance company before I started this process and Dr. Moran is in network. So if I have this right I can be billed for the deductible. So should I continue to go ahead with this. I am getting really frustrated.