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Mistfit7

blue Cross blue shield in network surgeons

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Mistfit7

So i just now signed up for health insurance through my company. And my company choose to go with blue Cross blue shield and I am looking into seeing if anyone one you had surgery or know any doctors that are in or out network that works with them? Please let me know. 

 

So I guess I am considered "New" to the forums. I have 9 almost 10 yrs under my belt of transition and Real life setting. Whole nine yard. I've been saving hard earned cash to get where I am. And now I finally feel like I'm getting a break. 

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Jani

Hi Mistfit and welcome.  

 

The issue with company sponsored health plans, and any plan for that matter is the coverage is never consistent.  It depends upon what your HR people wanted to pay for (globally) i.e. if their budget was X and BC/BS offered a plan to fit that price that is typically how it goes.  There might have been a few "must have's" that HR requested though.  You have to look at the actual coverage sheet.  

 

 

Please join in the talk, "experienced" members are always welcome and helpful!  
 

Best of luck,

Jani

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Mistfit7

I didn't asked if the insurance would cover. I asked if anyone had or known a surgeon in or out of network that will work with BCBS. Money is not any issue here. Thanks

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Willow

Ever since the affordable care act, company sponsored plans have to meet the same minimum coverage requirements as Obamacare plans.  But, those same companies don't have to offer more coverage unless they choose to make options available.  If your state requires coverage for transition surgery then that is an added benefit.  A good deal of southern states don't where as states such as Vermont and California do.  There are a number of others so you will have to look up the required by state law coverage for your particular state.

 

Also, as I understand it, Medicare may or may not cover it.  Again, they left it up to each Medicare district to deal with when the law said it could be covered.  It is inconsistent depending upon where you live.

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Alex C

Hey Misfit

Willow is right on the money. I live in Calf and my surgeries are 100% cover.So read the fine print..Congrats on finally achieving your dreams...HORA... 

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VickySGV
8 hours ago, Mistfit7 said:

I asked if anyone had or known a surgeon in or out of network that will work with BCBS.

 

By working with them, I am guessing you mean, will they simply communicate with them and be part of a care team, and since you are saying that coverage is not the issue, that makes it better and harder all at once to answer you.  Dr. Meltzer and his partner Dr. Ley in Arizona both work with a number of health plans and their doctors.  So will just about any surgeon if you give them the necessary permissions and waivers of confidentiality.  My HMO did not cover GCS in 2013, and I had to "out of pocket" the surgery, but they were happy to work with Dr. Bowers in the form of providing her with my run-up physical information and test results, including an HIV test, and my release covered my first year of recovery after the surgery and Dr. B and my new Gynecologist had several phone consultations due to a yeast infection I developed, and even a collegial issue or two on general GCS Post Op care.  Dr. Meltzer had been my #2 possibility for surgery and as far as I last heard is going well.  It is a matter of you giving the HIPPA waivers to any of your doctors as to whether they would cooperate with each other.  Out a little further west here in CA, Dr. Mauricio Garcia who works out of Cedars / Sinai and Dr. Alexander Sinclair who has two hospitals he works at would both be good possibilities. 

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Raven1981

The Meltzer Clinic here in Phoenix, AZ takes BCBS.  Dr. Ley is awesome and knows her stuff.  She was trained by Dr. Meltzer.  They do all the surgeries from FFS, VFS, BA, GCS.

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Kirsten

Yeah the Meltzer Clinic is one of the top places in the world. And they ONLY take bcbs. They are very helpful with everything that’s needed to get everything covered as well. That’s where I am going myself. Just have to wait for Jan when I swap to bcbs. They are both amazing surgeons too. As of about 3 months ago Dr Ley had a 12+ month wait list and Dr Meltzer was over 24. So keep that in mind. I am pretty sure they told me I needed 345 dollars up front. And the balance of the 1800 deductible by surgery day. 

Also bcbs has a group that can also help you get all of the requirements they need before it can be approved. My contact is directly through my company. But I believe it is a service offered to all insured. I just don’t know how to get in touch with them directly cause I use my connection. But I’d ask when you talk to someone in support. 

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