Hi everyone!! California here :)

[sulichney]

This is my first post so bare with me if im a little out of the know still. Im in southern california and was wondering if anyone has had their sleeve performed by dr. Ara keshishian and/or has anyone ever done their suegery through anthem blue cross PPO with HRA and FSA and gow that all worked out. Ive asked my insurance company various times but they always tell me in a way where they sound like they are just giving me a computer generated text book reply and they breeze through it so fast i still dont fully understand it.
BTW...hi everyone and sorry for my typos...smartphone

[Julesmirage70]

Does this Dr. have a team that works through the insurance for you? I have humana PPO and had to talk to the beriatric division at my insurance and they told me where to go and who to see and basically who was covered. WHen I started this last summer I thought I would find the dr. first but they don't work that way, I couldn't even find through all the dr's on website in Humana who the doctors were. It was like a completly different part of my insurance co that handles the bariatric part for these surgeries. But once I left a message with this department I had to wait for a nurse to call me and set things in motion, she emailed me all the doctors (3) in Houston that my insurance covered with the exact hospitals that the surgery would be done at for my coverage. So $250 bucks later and a lot of co-pays Nov 26 I was sleeved. I hope this helps a little.
Jules

[mrsjoe]

I'm guessing the answer they are giving you is a canned answer that coverage is dependent on the combination of procedure code and diagnosis that is billed by your provider. I know when I tried to get a straight answer out of BCBS of Texas for my son's autism coverage that is basically what they said. I finally got the provider to give me the exact codes they would be billing, and only then did BCBS confirm it was covered.

Several of the doctor forms I have received while shopping around have provided the exact procedure code that would be billed and recommended asking your insurance about that code specifically. Has your doctor given you anything like that?

[Gail8]

I had my surgery with Kaiser, but I work for a Medical Software Company, so the reason they don't give you real numbers as of yet, will depend on the surgeon fees, anesthesia and what are specifically covered and percentages.

Once the real bill is produced (about 3-4 weeks out) you will know your real responsibility.

[sulichney]

Well my insurance has myself and my daughter. So i have 3000 deductible and 8000 out of pocket max. My company pays out 1500 to offset the deductible. With bariatric surgey my ins handbook says they require my surgery be performed at a center of medical excellence and the surgeon has to be in network. Well this surgeon is both in network and works out of a CME. I know i meet requirements for approval as my BMI is over 40%. Im just curious how it actually all broke down financially after approval was given...