Kristy5567 Posted July 2, 2007 Report Share Posted July 2, 2007 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!!! Link to comment Share on other sites More sharing options...
PAMMIE Posted July 2, 2007 Report Share Posted July 2, 2007 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!!! THAT'S AWESOME!!! I WISH MY INSURANCE COVERED LAPBAND Link to comment Share on other sites More sharing options...
COCO Posted July 2, 2007 Report Share Posted July 2, 2007 Hi Kristy5567, Thank you so much for your post. I did not even realize that was an option. My insurance covers it (Humana) but they give you such a run around and I did not want to deal w/ that so I just paid for it. I was just banded 6/29/07 (yeah!!!!) I am going to submit a claim and like you said the worst thing that could happen is that they deny it. Thanks again for that bit of information. I'll let you know how it turns out! COCO :-h Link to comment Share on other sites More sharing options...
dreamhappy07 Posted July 2, 2007 Report Share Posted July 2, 2007 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!!! 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 Link to comment Share on other sites More sharing options...
Kristy5567 Posted July 2, 2007 Author Report Share Posted July 2, 2007 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!!! Link to comment Share on other sites More sharing options...
snowbird Posted July 6, 2007 Report Share Posted July 6, 2007 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. Link to comment Share on other sites More sharing options...
Kristy5567 Posted July 7, 2007 Author Report Share Posted July 7, 2007 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 Link to comment Share on other sites More sharing options...
angelav Posted July 8, 2007 Report Share Posted July 8, 2007 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!!! Please write me back as soon as possible. I had surgery in April of this year and also paid out of pocket, well i got fiananced. I need to know exactly what you wrote because I also have bluecross blue sheild personal choice. Please contact me by email Linx2wealth@comcast.net or through the forum. I love the surgery but the monthly bill is killing my pockets. I too did not want to jump through the hoops. Again please contact me as soon as possible.How long did it take for them to respond? > Link to comment Share on other sites More sharing options...
snowbird Posted July 8, 2007 Report Share Posted July 8, 2007 Thanks, Kristy. We will give it a try! My husband has other health problems stemming from obesity, but I don't (yet) so maybe Blue Cross Blue Shield will at least cover his costs. As you said, the worst that can happen is that they turn us down. Link to comment Share on other sites More sharing options...
angelav Posted July 11, 2007 Report Share Posted July 11, 2007 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 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. Link to comment Share on other sites More sharing options...
sugarm123@msn.com Posted July 11, 2007 Report Share Posted July 11, 2007 Hi, I was banned the 9th of July. My insurance company United Health rejected my claim but with the help of a law firm Obesitylaw.com they haelp with my appeal for free. They were wonderful. If you feel your insurance company is being unfair look them up on the web...hopefully they will be able to help you. Mona Link to comment Share on other sites More sharing options...
Kristy5567 Posted July 11, 2007 Author Report Share Posted July 11, 2007 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 Link to comment Share on other sites More sharing options...
angelav Posted July 13, 2007 Report Share Posted July 13, 2007 Your right, I will remain positive. This is the best info I ever got from the forum. It will save me 8,000 dollars =D> Link to comment Share on other sites More sharing options...
angelav Posted July 18, 2007 Report Share Posted July 18, 2007 Hello everyone just to keep you posted.My insurance company has recieved the claim and its being reviewed. It is nothing like the power of prayer. Pray for me. I can use as much as possible. They said they should know the result in a few days. > Link to comment Share on other sites More sharing options...
dreamhappy07 Posted July 18, 2007 Report Share Posted July 18, 2007 Hello everyone just to keep you posted.My insurance company has recieved the claim and its being reviewed. It is nothing like the power of prayer. Pray for me. I can use as much as possible. They said they should know the result in a few days. > Hi angelav, What insurance do you have and how and what did you get from Rene/OCC? I have Regence BC/BS PPO and need to have Rene send me whatever it is to send into my insurance. That money(if I would get it), would be awesome in so many ways! Good luck and God answers prayers! Judy Link to comment Share on other sites More sharing options...
FurEllie Posted July 18, 2007 Report Share Posted July 18, 2007 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 Link to comment Share on other sites More sharing options...
2thebeach Posted July 18, 2007 Report Share Posted July 18, 2007 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 Link to comment Share on other sites More sharing options...
angelav Posted July 18, 2007 Report Share Posted July 18, 2007 Hi angelav,What insurance do you have and how and what did you get from Rene/OCC? I have Regence BC/BS PPO and need to have Rene send me whatever it is to send into my insurance. That money(if I would get it), would be awesome in so many ways! Good luck and God answers prayers! Judy An itemized detailed bill and a surgical report. Link to comment Share on other sites More sharing options...
dreamhappy07 Posted July 19, 2007 Report Share Posted July 19, 2007 An itemized detailed bill and a surgical report. Thanks and one more question...Did you get those things from Rene or just OCC? Did he/they send them to you by email or mail? Thanks again and good luck and keep us posted. Judy Link to comment Share on other sites More sharing options...
Kristy5567 Posted July 19, 2007 Author Report Share Posted July 19, 2007 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 Link to comment Share on other sites More sharing options...
angelav Posted July 19, 2007 Report Share Posted July 19, 2007 Thanks and one more question...Did you get those things from Rene or just OCC? Did he/they send them to you by email or mail?Thanks again and good luck and keep us posted. Judy justcalled the occ and the documents were faxed Link to comment Share on other sites More sharing options...
angelav Posted July 25, 2007 Report Share Posted July 25, 2007 My latest update. BlueCross Blueshield personal choice have my claim.I check it daily through there website. It went from pended to in-progress. Everyone I spoke to there sounded pretty positive except one lady. She seemed like the money would be coming out of her pocket.HoweverI will not focus on that. Seems like it's progressing so I am sure it's good news. Pleasecontinue topray for meI think it's working. Link to comment Share on other sites More sharing options...
dreamhappy07 Posted July 25, 2007 Report Share Posted July 25, 2007 Hi again, I am going to take that first step and get the ball rolling so I can hopefully get some reimbursement from my insurance. Just a couple questions for any of you...did your insurance have an exclusion regarding any kind of weight loss surgery or help? Mine did, but I was told before I drained my 401k to pay for surgery with Dr. Ortiz, I could try to go through the process and see what happens. Yeah right! No way! My other question is who do I email and/or contact at OCC to fax my itemized bill and surgical report? I probably asked this before, but I want to do it right. Sorry. Thanks bunches! Judy Link to comment Share on other sites More sharing options...
Kristy5567 Posted July 25, 2007 Author Report Share Posted July 25, 2007 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 Link to comment Share on other sites More sharing options...
dreamhappy07 Posted July 25, 2007 Report Share Posted July 25, 2007 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 Hi Kristy, thanks for the info. Do you think I could email Rene directly and he would fax them or should I actually talk to him. I am someone who hates calling people when I am sure or not if they are really busy. I don't like bugging people at work...LOL Judy Link to comment Share on other sites More sharing options...
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