Hospital in ins. group?

lisalynn
on 2/20/13 1:57 am - MS

Hi, I am looking for anyone who has any tips or experience with the bcbs blue advantage hmo and that have a dr. or hospital they have went to for surgery in the chicago suburb area.. looking for a surgeon and hospital with this insurance and my primary care dr is affiliated with edward hospital, so do i have to use a dr. from here or just from a hospital that my insurance covers? this insurance stuff is co confusing to me..

thanks for any help.

lisalynn
on 2/20/13 2:07 am - MS

I've been trying to find this info. on my insurance website but no luck

NEWMI
on 2/20/13 2:41 am - SILVER SPRING, MD
RNY on 03/18/13

HELLO HAVE YOU TRIED CALLING THE NUMBER ON THE BACK OF YOUR CARD EITHER MEMBER SERVICES OR PROVIDER LOCATOR....I DO INSURANCE BILLING AN IM SCH FOR MY WLS 3/4/13 AN I ALSO HAVE BCBS BUT IM IN MARYLAND..BUT IF YOU CALL THE NUMBER ON THE BACK OF YOUR CARD THEY CAN EVEN PUT IN YOUR ZIP CODE AND TELL YOU ALL THE ONES CLOSE TO YOU IN YOUR AREA..

ChristineB
on 2/20/13 7:22 pm - Western 'Burbs Chgo, IL

You should be able to look at a list of participating doctors and hospitals on the BCBS website. When I log in under my profile I can search for that info. What surgeon are you considering? Do you feel that you have to go to Edwards for your surgery because that is where your primary is out of? If you have surgery other than where your primary is out of happens all the time. Any good surgeon will give back a full report to the primary doc. Take for instance this past November I needed to have adhesions cleaned up and my WLS surgeon did it at Good Sam where my primary does not practice out of. Dr Rosen gave back a full written report to my primary.

I am with the other poster in that you should call BCBS and they will give you the info that you are seeking for your particular coverage. You must be in the Hinsdale/Downers area if you mentioned Edwards. Have you considered Life Weigh Bariatrics with Drs Rosen and Mikhail? They have a wonderful pre op and PO program. They will also help you sort out the insurance situation, their office staff that is.

 
Open RNY May 7
260/155/140 




 

lisalynn
on 2/24/13 3:33 am - MS

thank you, I have not heard of life weigh bariatrics before, I will check them out, and i have tried to find info online and i cant even find where i can log my info in and when i try to look up a physician the only option it gives me is a primary care physician....I guess I will call them, does anyone know if i can research and pick my surgeon and then just ask my doctor for a refferal for that surgeon?

thanks again

Nancy G.
on 2/24/13 3:53 am - La Salle, IL

I did not go through my doctor to find my bariatric surgeon.  I went online and looked up who was practicing.  I talked to people and I went to several seminars.  Then I interviewed several surgeons before I made my choice.  I wanted to make sure I could work with the surgeon and the staff.  That is highly important!

I also strongly advise that you call your insurance company and ask them to send you in writing their requirements and coverage of weight loss surgery.  You need to follow to a T all of their requirements to get approval for surgery.  The requirements that are in effect when you start the process are those you must follow all the way through the process.  It is not up to your doctor but YOU to make sure all the requirements are met. 

Most bariatric surgeons are familiar with the different insurance companies and their requirements and will work with you.  But it is YOUR responsibility to get all the required pre approved tests that your insurance requires.  The surgeon may not require that test but your insurance company may require it.  That is why it is VERY important you get it all in writing.  Insurance companies love to issue denials to save money.  It is easier to fight them when you have all of your t's croosed and i's dotted.  

Good luck! 

    Cat Lady

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