Kristy5567

I'm with you Donna... Take a look at my history (my signature), I'm at 3.5cc's and I'm experiencing some restriction, but hardly any weight loss, and I'm eating very healthy, walking, and everything else I am supposed to do!!! If anyone has any input, it would be appreciated!

Kristy

I HAVE BLUE CROSS/BLUE SHIELD FEP THROUGH THE UNITED STATES POSTAL SERVICE, AND I LIVE IN MICHIGAN!

O.K. so my insurance blantly said they do not cover weight loss surgery, but Dr. Ortiz repaired a hietal hernia I had, what does everyone think should I try and get reimbursed for some of the cost?

IT NEVER HURTS TO TRY!!! THE WORST THAT CAN HAPPEN IS THEY CAN DENY YOUR CLAIM!!! TRY, AND TRY AGAIN!!!! GOOD LUCK!!!

KRISTY

Well, my insurance company lost my claim I guess because I found out a month later after mailing them, there is nothing in their system about any international claim. poop!

Do I need more of a specific itemized bill other than what the cost was for the surgery and all the other doctors? They didn't say but that I should make sure I have an ITEMIZED bill of the costs for the surgery. I did get one, but not so specific that it says how much and what meds I took and so on like that.

Any help you could give would be really helpful before I submit them again.

Peace,

Judy

You are going to want itemized billing and detailed surgical reports, they will most likely be in Spanish, but the insurance companies have translators... It will detail what medication you were given when, how much was charged for it, and so on and so forth... Good luck to you!

Kristy

THANKS KRISTY FOR ALL YOUR INFO ON INSURANCE. I WAS BANDED JUNE 11 2007 AND AM GOING FOR MY FIRST FILL AUG 20. DO YOU THINK I SHOULD CALL RENE AHEAD OF TIME TO GET AN ITEMIZED BILL FOR INSURANCE OR DOES RENE SENT THE PAPER WORK IN IF I GIVE HIM MY INSURANCE INFO. I WOULD BE DO GRATEFUL IF MY INSURANCE HELPED PAY FOR THIS. MY WEIGHT LOSS HAS SLOWED WAY DOWN, INFACT, I LUCKY IF I DON'T GAIN WEIGHT BEFORE AUG 20. CAN'T WAITE TO BE FILLED. DAR

OCC doesn't have anything to do with your insurance, other than to give YOU your surgery reports and itemized bills, if you need them. You can call him and ask for them, email him, or you can wait and ask while you are there... I have no idea how long it would take their office to get these things around, as I had them mailed to me.... Good luck to you!

Kristy

Hi Kristy,

Which form should I use to submit my claim? My insurance is Regence BC/BS PPO and their website has regular claim forms and international. On the international, it says for Puerto Rico, Jamaica or the Virgin Islands. Not sure if Mexico would be considered as part of that.

Thanks,

Judy

I did the international form... Good luck!

Kristy

First of all GOD bless Kristi for posting.Because of her I am being reinburst 5,250 towards the 8,500 procedure.I did exactly what she did and won. The reason it wasn't the total is because I was out of network.You guys are probably thinking you should have gotten it done in the states but with a bmi of 36 with no life threatning diseases they would not pay.So I decided to invest in myself and pay out of pocket.I considered it done until I read that great post.I jumped on the opportunity right away and about 4 weeks later the check is in the mail. Again thanks Kristi and thanks OCC for responding so fast and faxing the paper needed. >

GOOD FOR YOU ANGELAV!!!! EVERYONE SHOULD TRY SUBMITTING IF THEY HAVE INSURANCE, IT CAN'T HURT! I'LL KEEP PRAYING FOR ALL OF THE REST WHO ARE TRYING!!!

Kristy

Michelle

I am from Michigan and I saw a post from Kristi and she goes to Dr Kam at Barix Clinc in Ypsilanti, Mi. That is a lot closer than 3 hours away. As for cost, have e mailed Kristi and am waiting for a response.

Kari

Dr. Kam in Ypsilanti Michigan is a really great Doctor... He charges $150 for a fill (done blindly, but he knows what he's doing), x-ray costs $70 or $75, and the initial visit cost $250 (I think), but my insurance covered the first visit, even before they paid for the surgery! give their office a call... they are wonderful... Another suggestion is to go to www.obesityhelp.com, click on find a bariatric surgeon in the upper left corner, click your state, and start calling, that's what I did!!! Good luck to all!

Kristy

Hi Kristy,

Noone is responding and I was just wondering how long it takes for the forms to get to me....and either by fax or mail? I wrote Rene again to ask about how and when I should receive those. Thanks you!

Judy

I think it took me about a week to two weeks... My forms were mailed to me via USPS... Good luck to you, let me know if there is anything else I can help with!

Kristy

I've been checking the benefits for my Blue Cross Blue Shield policy, and they began covering lap band surgery in January 2007. They will cover the surgery if your BMI is over 40, or over 35 with co-morbidity (secondary medical condition resulting from your obesity). You don't need pre-approval, but you do need a referral from your doctor, so I'm getting the ball rolling by scheduling a physical and talking to my doctor. They also want you to have a psych exam to insure that you are mentally and emotionally able to handle the surgery and life thereafter. I've got my surgery scheduled for October 10 along with my husband, so we are greatly hoping Blue Cross comes through! My daughter had lap-band surgery last year and is a regular contributor here, but I won't embarass her by giving her name. This will really be a family affair for us; only my son will be left out of our surgery stories! Thanks so much, Kristy; without your post I would not have even checked to see if the surgery is covered. If all goes well, you have saved our family $16,000.

That is such a wonderful story!!! I'm glad to help anyone who needs it! It just pays to try, and insurance companies sometimes need to be pushed! I did NOT have to have a psych evaluation, or a referral (although both my regular dr and my diabetic dr both knew I was having it done, and encouraged me)... I have BCBS/FEP, and didn't even bother to check with them before I had it done, but heard afterward that they started covering the surgery as of January 07, so I just tried! And that is what everyone who has insurance should do! Good luck to all!

Kristy

I've been checking the benefits for my Blue Cross Blue Shield policy, and they began covering lap band surgery in January 2007. They will cover the surgery if your BMI is over 40, or over 35 with co-morbidity (secondary medical condition resulting from your obesity). You don't need pre-approval, but you do need a referral from your doctor, so I'm getting the ball rolling by scheduling a physical and talking to my doctor. They also want you to have a psych exam to insure that you are mentally and emotionally able to handle the surgery and life thereafter. I've got my surgery scheduled for October 10 along with my husband, so we are greatly hoping Blue Cross comes through! My daughter had lap-band surgery last year and is a regular contributor here, but I won't embarass her by giving her name. This will really be a family affair for us; only my son will be left out of our surgery stories! Thanks so much, Kristy; without your post I would not have even checked to see if the surgery is covered. If all goes well, you have saved our family $16,000.

That is such a wonderful story!!! I'm glad to help anyone who needs it! It just pays to try, and insurance companies sometimes need to be pushed! I did NOT have to have a psych evaluation, or a referral (although both my regular dr and my diabetic dr both knew I was having it done, and encouraged me)... I have BCBS/FEP, and didn't even bother to check with them before I had it done, but heard afterward that they started covering the surgery as of January 07, so I just tried! And that is what everyone who has insurance should do! Good luck to all!

Kristy

Just call the OCC, ask for Rene, and let him know what you need... They faxed the first set of documents to me, and my insurance company kicked it back for more information... OCC ended up mailing me the rest of the documents... I'm not sure as far as any exclusions from the insurance company! Now, I only wish they covered the fills... LOL Wishful thinking... Good luck to all! I'll be thinking of and praying for you all!

Kristy

Kristy, did you have any problems related to your weight? I also have BCBS but went to Dr. Ortiz because I thought he was the best, but if I can get BCBS to pay even PART of it that would be great I have no problems related to my weight though

The only problem I had/have is that I am juvenile diabetic... I did have some high cholesterol and my dr put me on lipitor, but that was for about 3-4 months, and I am no longer on any other medications other than insulin... Like I've said, it can't hurt to try! Good luck and I will be praying for everyone!

Kristy

I just submitted my information for reinbursement please pray for me. btw I see on my eob they spoke of pre- authorization for obesity surgery.Do you think that will ruin my chances since I went directly to occ without telling them? Let me know what you think. However I will still remain positive and watch god do his work. Agsin thanx for the info.

I DID NOT HAVE ANY PRE AUTHORIZATION, PRE APPROVAL, NO COUNSELING, ETC., ETC... I DO NOT THINK THIS WILL RUIN YOUR CHANCES AT ALL! I THINK THE OCC WAS QUITE HELPFUL IN SENDING THE RIGHT DOCUMENTS AND THE INSURANCE COMPANIES ARE STARTING TO REALIZE HOW MUCH MONEY THEY COULD SAVE OVER TIME IF WE WERE HEALTHIER PEOPLE!!! I WILL BE PRAYING FOR YOU, BUT JUST STAY POSITIVE!

KRISTY

Kristy,

My husband and I also have Blue Cross Blue Shield FEP and we are both planning to get the band in the fall. My question for you is, did you have other health problems stemming from obesity that BCBS considered in deciding to pay your claim? I am surprised that they would pay without some pre-approval. We will definitely give it a try! Thanks for sharing.

I am a juvenile diabetic, 22 years plus, I wear an insulin pump... I had also recently had high cholesterol, which my diabetic doctor had put me on lipitor... But that was about it... BCBS/FEP didn't ask for anything for pre-approval... I went and had the surgery figuring I'd have to pay for it (which I did to begin with)... I sent in the receipt (ask OCC for an itemized bill)... They sent it back wanting more detailed information, I called OCC, they sent quite a few forms to me that were in spanish, so I didn't understand what all they said, but I sent them into BCBS, and it took about a month and a half to two months to receive the check... Good luck to you and anyone else in trying to recover the cost of surgery...

Kristy

Hey Kristy,

Thanks for the info. I have Regence BC/BS PPO. Do you think they would do the same? What exactly do I have to do? How did you get that bill or report or whatever? Not sure what I need to send in to them.

Thanks again and way to go!

Judy

Well, first of all they asked for a more itemized bill... so, Rene sent me that.... That was when BCBS sent it back to me asking for more detailed reports (such as what medication I was given, how much I was given, times, cost of each medication, etc...)... I don't know if BCBS PPO would do the same, but the way I looked at it was why not try! Just call OCC and ask them for a detailed bill of the charges you paid, and whatever other information they are able to give you... then on the back of your insurance card it should tell you how to submit a claim or through your insurance's website...

And thanks again to everyone, and good luck to everyone too!!!! And don't ever give up the fight!!!

I just wanted to let anyone out there who is in the same boat I was... I was/am so tired of being overweight, so back in January and February I started doing more research on the internet on LapBand Surgery... I had researched it several times over the past few years, but didn't want to jump through all of the hoops to get insurance coverage... I scheduled and had the surgery done on 3/8/07 at the OCC... It was the best decision I ever made... When I got home and did some more reading on the subjet, I decided to submit the bill to my insurance (the worst they could do was deny me).... I sent it in, and they kicked it back to me for more information... I called and talked to Rene, and he told me they have everything the insurance company would need, but in Spanish... I called my insurance company (BLUE CROSS BLUE SHIELD FEP) and they said no problem since they have interpreters... Well, I just called BCBS FEP today and was told that they issued me a check in the amount of $7850 (the other $650 was my co-insurance)... THANK YOU SO MUCH RENE AND EVERYONE AT OCC!!!! And to anyone out there who had surgery or is scheduled to have surgery and you have insurance, it doesn't hurt to try!!!

I went to www.obesityhelp.com, in the top left corner there's a link find a: bariatric surgeon, click on this link, then click on your state, and start calling the drs in your area.... This is how I found myself a local fill dr, and I've had wonderful luck with their office... I've had fills with fluro, I've had fills without fluro, their nutritionist comes in and talks to me almost everytime, and they are reasonably priced (I pay $150 a fill)... Good luck to everyone in their search for local fill drs and in the journey to weight loss...

Kristy

am I correct in concluding that there's no way of even knowing what level of restriction you have until after the liquid phase is over?

Again, answering the question YOU posed to the forum...

even after the liquid phase is over, you will have NO restriction in your band...

Good luck to you in your weight loss journey...

I saw on a list that cream of wheat(runny) was able to be eaten, but it wasn't listed on Dr. Miranda's food list and when you could eat it. When can you eat it? Would it make the stomach work too hard right now almost 8 days out from surgery? I am starving here! I am drinking the protein shakes and started creamy soups, but looked at the instructions and I was a bit ahead of myself with the soup part. oops! Can I drink milk as a liquid as well?

Also, I take Lortab which is extra strength vicodin and have been crushing it and taking it with juice. Can it hurt the band at all? I have been taking it since the day after surgery and never had a problem until just recently about 2 hours after taking it and then all of a sudden with my next sip of juice, I got rather bad heartburn feeling in my throat. I hope I am still ok. The heartburn is gone now, but I really started to worry there.

Thanks for any help and/or advice you can give me.

Peace,

Judy

Judy,

Contact your doctor and ask for a scrip of liquid Lortab... I recently had some severe pain and an injury when I fell, and my doctor gave me the liquid lortab... It doesn't taste good, but it helps the pain... Good luck....

Kristy

Since I'm on liquids for the first 4 weeks post-op, and liquids are not restricted by the band, am I correct in concluding that there's no way of even knowing what level of restriction you have until after the liquid phase is over?

There should be no restriction what-so-ever in your band at 4 weeks, unless Dr. Ortiz or a fill Dr. of your choice has filled you at all... You are on liquids to help in the healing process so that the band doesn't slip or have any other problems that are possible... I thought I felt restriction at that point also, but it's not really... Even after my first fill, I was scared to drink too fast and careful about what I would eat (which we should always do anyway), but I didn't even feel restriction until my 3rd fill (I choose to be filled locally rather than to take time off from work to return to TJ)... Good luck to you!

try going to www.kayak.com, play with the plug-in information for a bit, I live in Michigan, so I try Detroit, Chicago, and even the smaller closer cities to my home.... You can have it check nearby airports also in your search, or 3 days before or after your trip, so you can see when it's cheaper to fly... It was cheaper when I went to fly out of one of the smaller cities closer to me than it was to go to Detroit or Chicago... Good luck to all!

Kristy

I found information for different doctors at www.obesityhelp.com, look at the top left corner, and click on find bariatric surgeon, then on the next page, click on the state you would like to look in, and a list of doctors comes up, I started calling all of them, and comparing the number or surgeries and other information available and found one that I really like! Good luck in finding a fill dr near you!

Kristy

WOW!!! You can definately see the difference... You look great! I wish we had set up some way to meet while I was there last weekend... I found it difficult being in Cancun, with too many liquid calories, and I can only imagine not having the support system! Keep up the wonderful job you've been doing! Get that other 40lbs. gone, and you could join in the Miss Universe contest in Cancun on Memorial weekend! LOL

I know that the video is not for some people, but I thought it was a great way for me to be informed about what would be done to my body. I was so tired, and/or doped up, I don't remember much about the morning of surgery, in fact, I don't remember much about that whole day, except sleeping and I know I made a few phone calls... LOL It helped to ease my mind and prepare me for the experience without having to have them take the time to explain it to me, although they would have, and some things were very explained. Good luck to all out there in bandster land...

Kristy