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Reached Lifeime Insurance Max. No Follow up Care?

bikrchk
bikrchk Posts: 516 Member
in Social Groups
So I reached my lifetime maximum for my sleeve procedure about 1/2 way through last year. I'm scheduled for my 1 year follow up and at this point neither the appointment nor the labs will be covered. Basically no follow up care will be covered ever again according to BCBS of KC. Seriously? I'm thinking about cancelling my 1 year follow up entirely. My Dr. is no longer with the practice, so I have no idea who I'll see, I was checked 6 months ago and labs were perfect, I continue to take my supplements as directed. I'm in my goal range and maintaining nicely. Thinking this can wait for my yearly physical in 6 months with my regular doc when the labs and the appointment will be covered in full because they will be coded as "well care". Thoughts?

Replies

  • pawoodhull
    pawoodhull Posts: 1,759 Member
    If your primary doc can follow up on the bariatric part with labs and such, why not? And, if you can communicate with your bariatric team via email, you can still get that help should you need it. I also have BCBS. Wonder if that's going to hit me at some point too.
  • msleelee35
    msleelee35 Posts: 14 Member
    I agree with Pat. Your primary doctor should be able to keep an eye on your lab work. I've never heard of such from insurance companies. I also have BCBS. What a bummer!
  • Losing_Sarah
    Losing_Sarah Posts: 279 Member
    Weird. Didn't know that could happen, although usually the company you work for chooses your plan, so must be specific to your plan. I have BCBS, too, but through MN and my hubby's job.

    I'd just wait and see my PCP if I were in that situation.
  • rpyle111
    rpyle111 Posts: 1,066 Member
    Bummer.

    Reading through my insurance plan, I didn't see anything about a follow up limit, just a one surgery per lifetime limit unless the second is tied to complications.

    Good luck. I would have my PCP contact the bariatric doctor and make sure that he/she (PCP) can cover all of the bases.

    Rob
  • authorwriter
    authorwriter Posts: 323 Member
    I didn't know that could happen either. Good to know.

    Yes, just let your PCP take over your care. I found at my surgeon's office, even though they have the followup appointments, they don't want to prescribe anything for you, etc. They seem more like CYA visits then anything else. So they don't get themselves in trouble.

    I just got my 6 month labs, although it's really only 4.5 months. For some reason there were no appoints for my true 6 months, which is why I think it's mostly BS. but I'll go because i don't want my insurance saying I didn't do proper followup so they want to charge back on the surgery. Anyway, they drew like SIX vials of blood and collected urine. I've never had so much drawn at one time. As it turns out, I brought the order to my PCP and he reordered the labs under his own thingie just to make it go smoother at his in office lab.

    so yeah, if you feel well, and the visit or labs associated with it won't be covered, let your PCP take care of it. and if you're feeling sick in the meantime, see your PCP and maybe he'll order the labs earlier. Congratulations on your success and may it continue forever for you!

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