INSURANCE COVERAGE -- THANK YOU OCC!!!

[snowbird]

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.

[Clynn]

but I won't embarass her by giving her name.

Why stop now?

[snowbird]

Why stop now?

That's my girl!

[PAMMIE]

That's my girl!

CLYNN LOL

[FurEllie]

Why stop now?

:lol:

I had a BMI of 39 and had the surgery 3/07. No psychiatric examinations. I'm going to try but I have a MASSIVELY huge deductible since I'm self insured. But even getting a little something back would be nice

[dreamhappy07]

Ok, I emailed Rene at OCC and asked for the itemized detailed bill and surgical report. I also left my work number and work fax number. I hope this will work and also getting my insurance to pay me some back.

Peace,

Judy

[Banded-May23-07]

OMG! Amazing story... your have motivated me to do some research... I am off to United Health Care's website. I will let us know what I discover, thank you for your post. I love this website! > Thanks!

[dreamhappy07]

Well, I received an email yesterday from Rene at OCC saying they will send the itemized bill and surgical report as soon as possible. Good news so far.

Anyone know how long it takes to get it? I left my work fax #'s, but not sure if they will mail it or fax. He didn't say. lol

Peace,

Judy

p.s. I was checking my insurance website and looking at the claim forms. They are in .pdf and will have to print them out and attach the reports to them, etc. I am really stressed about the exclusion in my insurance for any weight loss help and especially out of the country. But, we shall see.

[Kristy5567]

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

[Kristy5567]

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

[dreamhappy07]

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

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

[Kristy5567]

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

[minnie]

thanks for the info.. i will file with my insurance after i get back.. it is a covered benefit under my plan but i have tried for 1 year to get them to approve it... after the 3rd denial from them, i decided to pay for it myself ( financed ) but at least im getting it .... its sure is worth a try! congrats my surgery date 8/17/07

I also financed. But I will put in a claim to Tri-care Prime after my procedure and pray. My surgery date is 8/16/07.

Minnie : )

[2thebeach]

I also financed. But I will put in a claim to Tri-care Prime after my procedure and pray. My surgery date is 8/16/07.

Minnie : )

i have united healthcare - good luck to both of us

[angelav]

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. >

[dreamhappy07]

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. >

That's great angela! I haven't gotten anything by fax or mail yet from Rene and he has emailed me in reply to the reports twice now. I don't think he speaks good english by email, but does get the point across that he will mail or fax them to me.

I hope soon.

Peace,

Judy

[dreamhappy07]

Hey,

It was amazing. Right after I posted my recent reply, I got all the forms needed from Rene through my work fax! How cool is that?! So, now I need to send them into my insurance through a claim form?? Then, play the waiting game. LOL I really hope and pray this works, cuz that money or most of it I could really use.

Thanks all and please keep me in your prayers. My insurance can be very strange and stubborn.

Peace,

Judy

[Kristy5567]

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

[dreamhappy07]

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

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

[Kristy5567]

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

[dar]

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

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

[Kristy5567]

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

[akgirl]

What did the bill you received from OCC look like? Rene emailed me a surgical receipt. I would think the ins co. would want an actual bill with procedure and diagnosis codes before they will process.

I was banded 6/25 by Dr. Ortiz, I got my first fill there on 8/15. 2.3 cc's

[dreamhappy07]

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

[Kristy5567]

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