Re: BCBS....Good News, Bad News

[Guest guest]

Sorry, that last post was a bit unclear. " Standard Benefits " are not

as good as " Preferred Benefits " , which in my plan, pay virtually

100%. I want to be PREFERRED dammit!

> I know a lot of you here are interested in BCBS approvals....I have

> BCBS Vermont. I applied for prior approval for BPD/DS with Dr.

Hess

> two weeks ago, and......

>

> It just came back approved, that's the " good news " .

>

> The " bad news " is that they approved it at standard benefit levels,

> which leaves me with a 30% co-pay and a $500 deductible, on top of

> the $2500 that Hess asks for.

>

> Their reasoning was that the procedure was available in network.

It

> isn't, believe me, I've looked. I suspect it's going to be the old

> RNY argument, will know more shortly.

>

> So now I have to convince them of the benefits of the " Long Limb

RNY "

> vs. the standard RNY.....this after I FRIGGING SPELLED IT OUT FOR

> THEM, COMPLETE WITH DIAGRAMS in my original request.

>

> Ahh, if it was easy, everyone would do it....

>

> jj

[Guest guest]

> > The " bad news " is that they approved it at standard benefit levels,

> > which leaves me with a 30% co-pay and a $500 deductible, on top of

> > the $2500 that Hess asks for.

> >

>

You might also want to check if there is an out of pocket limit. I

think every policy I've had has had one but the amounts vary greatly.

Once you hit the out of pocket limit my understanding is they will

pay at in-network benefits. My policy also has something that what

you pay in the last three months of the year applies to next years

deductible and out of pocket so my November surgery will count for

this year and next.

[Guest guest]

Thanks gang...I was so " befuddled " with the situation I never thought

of this stuff. Far out!