Dr. Miles or Dr. Schmitt patients

JASON R · 06-26-2008, 08:23 PM

Quote:

Originally Posted by aprilapple

I have BC/BS (PEEHIP) and am using photos from the past 3 years to document my weight history. Like many overweight people, I have spent many years dreading the doctor's office. Has anyone gone through the approval process using photos? What can I expect? Doe it take longer to get approval?:confused2:

aprilapple, i just got my approvel letter today

in the mail and i also used photos like you. i gave them about 5 years worth of them. and about 2 per year. i wanted to make sure they had alot of them. so yes it works fine. and it took about 2 weeks from when she sent it in to get the petter back. and a few other things to tell you. go ahead and get your sleep aplna (sp) done. and you got to do a 1 on 1 class with the nutritionist also. before they send it in. dont wait to the last min. to get everything done.

aprilapple · 06-26-2008, 08:49 PM

Quote:

Originally Posted by JASON R

aprilapple, i just got my approvel letter today

in the mail and i also used photos like you. i gave them about 5 years worth of them. and about 2 per year. i wanted to make sure they had alot of them. so yes it works fine. and it took about 2 weeks from when she sent it in to get the petter back. and a few other things to tell you. go ahead and get your sleep aplna (sp) done. and you got to do a 1 on 1 class with the nutritionist also. before they send it in. dont wait to the last min. to get everything done.

I am about to cry. That is so encouraging! I did have the sleep study done. Nutritionist? This is the first time that I have heard that. naomi didn't mention it.

aprilapple · 06-26-2008, 09:09 PM

Jason, do you have PEEHIP as well? Does anyone have Peehip? what are my out of pocket expenses for the surgery?

JASON R · 06-26-2008, 10:39 PM

no i dont have peehip but i do have bc/bs ocal goverment heath insurance plan. yes you need to call naomi and ask her. but she want be back in until tuesday. i didnt know to the last min. and she told me. you might not have to have it with peehip. not sure on out of pocket yet. bt i do know a girl that had it done and she had to pay like 900 bucks out of pocket with bc/bs.

aprilapple · 06-27-2008, 02:30 PM

Hey Jason,
I hate that Naomi will be out until Tues. I was really hoping to get my stuff sent to bc/bs today. I did call bc and they said a nutrition visit was not required and...:drumroll please: the surgery is covered at 100%! My out of pocket expense is a $100 copay.

JASON R · 06-27-2008, 04:43 PM

ok i just called bc/bs and they told me that they will pay 50% of the doctors fee. and 100% with a 100 dollar co-pay of st. vincents east fee. so you might want to make sure. but i will ask naomi tuesday about it. and report back.

so if theres anyone on here that has got bc/bsof alabama please let me know what you had to pay.

Di4AU · 06-30-2008, 11:00 AM

Quote:

Originally Posted by JASON R

ok i just called bc/bs and they told me that they will pay 50% of the doctors fee. and 100% with a 100 dollar co-pay of st. vincents east fee. so you might want to make sure. but i will ask naomi tuesday about it. and report back.

so if theres anyone on here that has got bc/bsof alabama please let me know what you had to pay.

It's going to vary depending on your BCBS plan. Mine paid 80% of the doctors fee. 100% hospital. Naomi will be able to tell you. It's usually best to email her, as it's pretty hard to get her on the phone.

Savedbygrace · 06-30-2008, 04:07 PM

Quote:

Originally Posted by JASON R

so if theres anyone on here that has got bc/bsof alabama please let me know what you had to pay.

I have BCBS PPO and it paid for the 80% for the surgeon and anesthia.
I had a $150 outpatient copay, then on my 20% of the rest
I paid Dr. Miles - $452.00 - Anesthia - $130.00

It does depend on your plan though!! But that's what my experience was.

bandofhope · 07-01-2008, 09:55 PM

Savedbygrace...thanks so much!!! You have answered the question I have not been able to get a good answer to.. the BCBS PPO money question! I appreciate your input on the site! Thanks!

Savedbygrace · 07-02-2008, 07:04 AM

Quote:

Originally Posted by bandofhope

Savedbygrace...thanks so much!!! You have answered the question I have not been able to get a good answer to.. the BCBS PPO money question! I appreciate your input on the site! Thanks!

You're welcome! I know exactly how it feels to go into it blind. I had called BCBS, the surgeon, the hospital, researched online... and then I FINALLY found a bandster that would share their EOB (Explanation of Benefits) with me. It's scary enough going into something like this.. but to have NO clue on how much money you'll be out of pocket.... well it doesn't make it easier! Of course, everyone's benefits are different but some idea is better than none.

Well .... I go for fill #2 today. I'm hoping for some restriction this time!!!!!
This month has been a slow loosing month! I think maybe a total of 4 pounds.. I know I know .. that's a pound a week and that's average but dang I need it to move a little faster!

I'll be leaving for MS tomorrow so hope everyone has a WONDERFUL and SAFE 4th of July!

Southern Missy · 07-06-2008, 11:10 PM

I'm going for another fill tomorrow but in the meantime, I have had a pretty good weekend except for getting stuck a few times and finally, today, had my 1st PB. As bad as I was stuck, it was a relief to have it. Not exactly an experience that bears repeating, though. How bout you girls, Grace, Shawna, Diane, any yet?

Fordgal88 · 07-07-2008, 07:14 AM

Hi Southern,

To answer your question.... Yes! 2 Times to be exact. I am still trying to get used to eating slower. I am so used to being on the run that it is a big adjustment to taking my time and chew like I should. Now I try not to let myself get too hungry so I will not feel the need to shove food down my throat. The first time was when I got to hungry and tried to scarf down a burrito which was also bad because I learn that I should not eat anything that doesnt involve using a fork or spoon, seems when I put something close to my mouth I take WAY too big of a bite. The next time involved a piece of leftover grilled chicken (note: the microwave tends to dry lean meat out!).

So how was your 2nd Fill Wendy? Any restriction yet? I sooo cannot wait to have REAL restriction. I had some the first few days after my 1st fill and it was SOOO nice. But now its back to the way it was. I was scheduled for next Tuesday, but they called and resceduled for the following Monday - UGH! So 2 more weeks of this!

I hope everything else is going well for everybody, please keep me in the loop of whats going on with ya'll!!

Shawna

Fordgal88 · 07-07-2008, 07:21 AM

Oh another question???

Has anyone else had any claims filed by Dr. Miles and Schmitt's office yet? I have not had a single claim filed by their office yet (My surgery was on May 6). Now of course the hospital claim was filed in less than 2 weeks, but nuthin from the dr.'s office!

The good thing is my husband's old insurance is still active. His company closed (well moved their production from Bham to Wadley sp?) in February. So we took my insurance through St. Vincent's (which stinks cuz everything is double). But whenever they file a claim on my St. Vincent's insurance it automatically files it against my husband's old insurance and it usually ends up paying my co-pays. So they did that with my hospital claim and it paid my $100 co-pay! So I am due back a check from good ole St. V's!

Just wondering if it was just me or are the Dr's filing slow?

Savedbygrace · 07-07-2008, 07:33 AM

Good morning ladies!!!

Missy - I have had a few episodes of ... this isn't going down good. It hurts! My problem is like Shawna.... I realize I'm eating too fast. So if I slow down it's usually fine.. if it's something I wasn't really wanting BAD.. I just stop eating it. I haven't had to PB anything yet and hope I don't. The pain in the chest is rough enough!!!

Shawna- the second fill went fine. I am at 5.5 cc's now. We left for MS the day after and gosh it seems that all we do is eat down there. We had a family reunion so that means nothing but food. I do feel more restriction in the way that I have to eat slower and chew better. As far as being less hungry... I hope to see that begin now that I'm hope and staying busy... vs. just having nothing to do but eat.

Also... It did seem to take a while for Dr. Miles' claim to go through on mine too. I can't remember how long but it was a while. I'm sure they have already filed it but are now having to send documentation to support the claim. We go through that with alot of our claims (at my job). That's great that they are paying your copays!!!!!!!!!

Hope everyone has a wonderful week!!

JASON R · 07-07-2008, 08:03 PM

ok this is making me very mad! i have been approve for almost 2 weeks and nothing from dr.miles office. i have called everyday they been open(except when neomie was not there). and nothing. i told them today i need to talk to her or someone that knows what to do next. shes always with another patient. i think they need to get another person to help out with this part. oh, and i also email her 3 times.

and thanks everyone with the answer to the bc/bs question. i got ppo but its 100% or st.vincent and Anesthia. with a 100 co-pay. and 50% for dr.miles. so i guess what every it cost from him i will pay 50% of it.