Question:
do anyone know a Dr.that will still do the GASTRIC BYPASS surgery in MI after may 5
I was approverd for the surgery but now BTC will no longer accept my coverage BCBS_PPO I also heard that BCBS is no longer letting people have this procedure done please give me some feed back ([email protected]) — zarconai T. (posted on April 8, 2003)
April 8, 2003
I'm sorry to hear that. I had it done at BTC in MI having BCBS in Sept.2002
and im wondering now if they will still cover my post-op visits. I know
they have Doctors in Wyandotte Hospital that do it, that is where my Doctor
was going to send me but I decided to go w/ BTC. Good luck, I hope it works
out for you!
— Sandy M.
April 8, 2003
Hello I am having surgery at the Ypsilanti BTC on April 25, just barely
making the cut off. I also have BC/BS PPO, and received a letter from BTC
stating that they will no longer take BC/BS as of 5-5-03 and that is
because BC/BS will not cover enough of the surgery to make them able to do
it uo to their high standards. The other surgeons are still doing the
surgery as far as I know. Would have to check the surgeons list, then call
and inquire with them. I hope you can find a suitable doctor to help you.
— Kevin M.
April 8, 2003
Check out the Cori Center in Warren, MI. They have excellent surgeons
there & accept BCBS. I had originally gone to BTC in January, but it
turned out that I had the BCBS PPO Plus, which they didn't accept, so I had
to find another surgeon. I am so glad that I didn't have it at BTC. I
loved my surgeon Dr. Shuchtnecht. Dr. Wood, who is also in the office, is
awesome too....he came to check on me a couple of times in the hospital.
You can learn more about the doctors at their website at
www.weightlosssurgery.com
They do their surgeries out of Harper Hospital in Detroit. Their office is
on East 10 Mile in Warren.
If you need any more information, let me know.
— jarrett318
April 8, 2003
It makes me very suspicious of how much BTC charges if they say the
reimbursement from BCBS is too low. I'm in WI, so charges should be
similar. I just received my EOB for the surgeon's bill and they paid
$7,440 of the $12,000 billed. However, they truly charge $6000 total for
the surgery. They have both bariatric surgeon's do the surgery and
therefore charge the full fee for each surgeon but put a modifier on the
claim that says to pay each surgeon 1/2 of their fee ($3000) for a total of
$6,000. Consequently because they paid $7440 the surgeon's office has to
send the extra $1,440 back because it technically has been processed wrong.
According to this website the $6,000 my surgeon charges is on the high
side, yet BCBS was willing to pay substantially more. If BTC is charging
more than this then they are charging too much.
<p>My hospital charges (paid in full) were $13,800 complete for
surgery and 3 days in the hospital etc. Although I did bring my own
medications or the bill might have been $20,000 (I know exaggeration) with
what hospitals charge for medications. It always ticks me off when I see
$4 for a pill that costs me about $.15-$.25. My anesthesiologist's bill is
$1640, which hasn't been processed yet. I also had a pulmonologist and
internist following me in the hospital and their bills were paid in full.
My total charges with standard pre-op testing was $26,025. This did not
include sleep studies or Cardiolite stress test, which are not part of the
actual surgery costs. But in both cases they were paid in full.
<p>This issue on payment could actually be that BTC is not billing
things correctly and therefore are not getting the reimbursement they
should. BCBS can be picky how things are submitted, that I will agree
with, but my 15 years of experience working with them is that if you keep
after things they get paid. Other than deductible and co-pays I have had
probably less than $250 that was not paid in 15 years. There were some
major dollar amounts not paid on some claims but those were agreements
between BCBS and the provider, so I do not factor those in because the
provider has agreed to it. With BCBS you just need to learn to play their
game. Once you figure that out then 99.9% of everything can be resolved
and paid. It sounds like one of the other posters gave you a good resource
that takes your insurance. Good luck and I hope you are able to get
something arranged soon. Chris
— zoedogcbr
April 8, 2003
Hurley Center for Comprehensive Weight loss. Dr.Obeid, Flint,MI. I had my
surgery done there and the staff was wonderful and so is the doctor! Beth
— Elizabeth C.
April 8, 2003
Its truly sad. I heard BTC is getting way less money for surgery from the
blues than any other insurance company pays. Plus BTC has excellent results
with a very low death rate, and low readmission rate after surgery too.
Patients tend to do better with high volume experienced surgeons and BTC
has done nearly 20,000. Now thats experienced. Hopefully if enough blues
customers complain it will change. My personal opinion is the blues gave
BTC a hard time hoping to save money by reducing the total number of people
getting surgery. Of course this is speculation on my part. If I had BCBS I
would complain to my employer and fight for another carrier. Blues loosing
customers would get their attention. BTC like any company HAS to cover
their expenses. WLS is bottomline a business wether its a individual
surgeon or huge company. I have a small business, like everyone else you
have o cover your costs.
— bob-haller
April 8, 2003
Call the Hurley Center for Comprehensive Weight Loss in Flint! Their
surgeons and staff are great! Their phone number is 800-871-1811! BEST OF
LUCK!
— Jennifer H.
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