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INSURANCE COVERAGE -- THANK YOU OCC!!!


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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. ><'

congrats! i am filing with my insurance company now but they want a diagnosis code and a procedure code. did your insurance ask for these ? do you know what they are?

once again, i am soooo happy for your success ><'

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I've yet to send my forms in to my insurance company. I have got to get moving. It took Rene about two to three weeks to mail my records. They were all in English and there is about 4- 5 pages. Hopefully I have all I need. I have BCBS through Teamsters but since Dr. Ortiz is out of network, I have to send my claim to Teamsters for reimbursement. I hope there isn't a problem. They are pretty lenient about preapproving lapband, but I flunk the psycho. evalu. due to depression.

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I've yet to send my forms in to my insurance company. I have got to get moving. It took Rene about two to three weeks to mail my records. They were all in English and there is about 4- 5 pages. Hopefully I have all I need. I have BCBS through Teamsters but since Dr. Ortiz is out of network, I have to send my claim to Teamsters for reimbursement. I hope there isn't a problem. They are pretty lenient about preapproving lapband, but I flunk the psycho. evalu. due to depression.

Hi Kari,

I have to resend my forms in because the others got lost and then found out I need an itemized bill that will probably be in spanish, but that won't be a problem. I have Regence BCBS PPO and there is an exclusion in my benefits for anything related to weight loss, including surgery, so if I get money reimbursed, then I know anyone can. I was already told I would be, but time will tell.

Good luck with yours. :)

Peace,

Judy

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congrats! i am filing with my insurance company now but they want a diagnosis code and a procedure code. did your insurance ask for these ? do you know what they are?

once again, i am soooo happy for your success ><'

i got the dx code and procedure code from rene at OCC :) .. :)

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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

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Judy....

I would love to hear if you find out anything. I also have Regence - Preferred (washington state). I knew about the exclusion and didn't even think about trying. It would be so great if I were able to recoup even a small fraction!!! Could you possibly email me if you do hear something?? I don't check the forum often. My email address is: momyto2@comcast.net

Thanks so much!!

Theresa :)

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i got the dx code and procedure code from rene at OCC :) .. :)

Hi Dawn,

when Rene sent me my forms to be submitted they were all in English. He didn't send a Dx code or a procedure code. I have not gotten an answer from the claim I submitted. I'd better check up on it Monday while I am on my lunch break. I am really praying I get a little back.

Dawn, I just called your house and left you a message. I wish I was going with you to get my first fill. I hope to get a fill with a local doc here. I can't leave the kids to make a trip to TJ.

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OK, I swear I thought it was here somewhere but I can't find it. Getting close to the end of the year and I need to get my (still fat, but getting less so) butt in gear and get this info from Rene. Does someone have his email address and the exact info I need to ask him for?

I also have BCBS. It's an independent policy. Who knows if they'll pay. I was kinda not paying as much attention to this as I should have since I have a very high deductible and the OCC surgery being claimed really wouldn't give me a whole lot back. BUT I just found out I need a hysterectomy, so if I can get the lapband put towards my deductible, the hysterectomy will be a LOT LESS expensive.

Again, Rene's email address and EXACTLY what it is BCBS is asking for.

Thank you guys SO much for doing all this!!! :) :) :) :) :)

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Judy....

I would love to hear if you find out anything. I also have Regence - Preferred (washington state). I knew about the exclusion and didn't even think about trying. It would be so great if I were able to recoup even a small fraction!!! Could you possibly email me if you do hear something?? I don't check the forum often. My email address is: momyto2@comcast.net

Thanks so much!!

Theresa :)

Sure, I will definitely let you know. I am still waiting for the itemized detailed surgical report from Rene. I will email him and get those things mailed to the insurance right away. I was already told from Regence that I would be reimbursed but they didn't say how much. They probably have to review the claim and all. So, I am really expecting some reimbursement I hope.

Peace,

Judy

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OK, I swear I thought it was here somewhere but I can't find it. Getting close to the end of the year and I need to get my (still fat, but getting less so) butt in gear and get this info from Rene. Does someone have his email address and the exact info I need to ask him for?

I also have BCBS. It's an independent policy. Who knows if they'll pay. I was kinda not paying as much attention to this as I should have since I have a very high deductible and the OCC surgery being claimed really wouldn't give me a whole lot back. BUT I just found out I need a hysterectomy, so if I can get the lapband put towards my deductible, the hysterectomy will be a LOT LESS expensive.

Again, Rene's email address and EXACTLY what it is BCBS is asking for.

Thank you guys SO much for doing all this!!! :) :) :) :) :)

LOL The email address for Rene that I use is rene@obesitycontrolcenter.com. He has responded to me very well too. :)

Hope this helps.

Judy

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Sure, I will definitely let you know. I am still waiting for the itemized detailed surgical report from Rene. I will email him and get those things mailed to the insurance right away. I was already told from Regence that I would be reimbursed but they didn't say how much. They probably have to review the claim and all. So, I am really expecting some reimbursement I hope.

Peace,

Judy

Really?? Exclusion and all and they still said there would be a reimbursement of some sort?? I'm so surprised!! So... you started the process with their online international form?? I'm thinking I may need to give it a shot too. Like Kristy said... it can't hurt to try I suppose. I guess I'm just shocked!! Please keep me posted. I am VERY interested to know what you find out!!

Thanks so much!!

Theresa

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  • 2 weeks later...

OK...Finally heard back from insurance and they need dates and amounts for services. Was that what you got Kristy and Angela from OCC when you asked for the itemized billing report that was mailed to you? I am still waiting for that and Rene told me it was mailed last Monday the 24th. Still haven't got it yet.

Carolyn got really upset with me when Rene was on vacation and tried to reply from an email I sent Rene about that report. She sent me the one through email that I already had and we wrote back and forth trying to figure it out. I could tell she was really miffed with me or bothered by the fact that all Rene's emails was being forwarded to her.

I hope I get it soon, I need to get this ball rolling and hopefully have some extra money for Christmas. ; )

Please let me know if that is what you all got too.

Thanks!

Judy

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Hi Dawn,

when Rene sent me my forms to be submitted they were all in English. He didn't send a Dx code or a procedure code. I have not gotten an answer from the claim I submitted. I'd better check up on it Monday while I am on my lunch break. I am really praying I get a little back.

Dawn, I just called your house and left you a message. I wish I was going with you to get my first fill. I hope to get a fill with a local doc here. I can't leave the kids to make a trip to TJ.

Hi Minnie,

I didn't go to TJ for my fill. I ended up getting it here last Wednesday. I didn't feel a thing. They told me that they would be taping it for training purposes. I'll have to tell you about it on the phone. It was pretty funny.

I have sent mine in to insurance also. I mailed it twice and they say that they've never received it. So I faxed it. We'll see what happens, but it sure would be nice if they would reimburse us for some of it anyway.

I call you soon.

Dawn

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Hi Minnie,

I didn't go to TJ for my fill. I ended up getting it here last Wednesday. I didn't feel a thing. They told me that they would be taping it for training purposes. I'll have to tell you about it on the phone. It was pretty funny.

I have sent mine in to insurance also. I mailed it twice and they say that they've never received it. So I faxed it. We'll see what happens, but it sure would be nice if they would reimburse us for some of it anyway.

I call you soon.

Dawn

Hi Dawn,

I am still waiting to hear from my insurance. I will keep my fingers cross. I will call this weekend when I am off work.

Minnie

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PLEASE! I HOPE SOMEONE THAT HAS BEEN REIMBURSED CAN HELP ANSWER MY QUESTION.

I HAVE BEEN EMAILING BACK AND FORTH WITH RENE AT OCC AND HE HAS BEEN SO PATIENT AND UNDERSTANDING. I WROTE EARLIER THAT MY INSURANCE FINALLY GOT BACK TO ME ABOUT MY CLAIM AND WANTED A DETAILED ITEMIZED BILLING STATEMENT FROM OCC FOR ALL SERVICES AND DATES(OF COURSE THERE IS ONLY ONE DATE), AND HE FAXED ME WHAT I ALREADY RECEIVED BEFORE PLUS A BLOODWORK AND EKG COPY.

DID I ASK FOR THE WRONG THING? WHAT EXACTLY WAS THE ITEMIZED DETAILED REPORT THAT YOU ALL GOT? ALL HE SENT(TWICE NOW) IS THE DATE OF SERVICE AND THE AMOUNTS FOR EACH DOCTOR TO THE TOTAL I PAID FOR EVERYTHING. I AM SO CONFUSED AND DON'T WANT TO BOTHER POOR RENE ANYMORE.

MAYBE I SHOULD ASK FOR HIM TO FAX ME EVERYTHING HE HAS, BUT I THINK HE ALREADY DID.

HELP PLEASE WOULD BE SO APPRECIATED.

THANK YOU!

JUDY

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Hi Judy,

I asked rene for my surgical report. I think that is what you are looking for. I too got the other info that you received along with the surgical report. Hope this helps.

PLEASE! I HOPE SOMEONE THAT HAS BEEN REIMBURSED CAN HELP ANSW

ER MY QUESTION.

I HAVE BEEN EMAILING BACK AND FORTH WITH RENE AT OCC AND HE HAS BEEN SO PATIENT AND UNDERSTANDING. I WROTE EARLIER THAT MY INSURANCE FINALLY GOT BACK TO ME ABOUT MY CLAIM AND WANTED A DETAILED ITEMIZED BILLING STATEMENT FROM OCC FOR ALL SERVICES AND DATES(OF COURSE THERE IS ONLY ONE DATE), AND HE FAXED ME WHAT I ALREADY RECEIVED BEFORE PLUS A BLOODWORK AND EKG COPY.

DID I ASK FOR THE WRONG THING? WHAT EXACTLY WAS THE ITEMIZED DETAILED REPORT THAT YOU ALL GOT? ALL HE SENT(TWICE NOW) IS THE DATE OF SERVICE AND THE AMOUNTS FOR EACH DOCTOR TO THE TOTAL I PAID FOR EVERYTHING. I AM SO CONFUSED AND DON'T WANT TO BOTHER POOR RENE ANYMORE.

MAYBE I SHOULD ASK FOR HIM TO FAX ME EVERYTHING HE HAS, BUT I THINK HE ALREADY DID.

HELP PLEASE WOULD BE SO APPRECIATED.

THANK YOU!

JUDY

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I just got my packet from OCC - WOW! It has step by step instructions on everything they did (in English), my weight, body fat (ugh), EKG, etc. It's EXTREMELY well done. Now to convince BCBS ;)

Thanks OCC!

Hmmm...I wonder if you got the same thing I did, but mine was faxed to my work and also the second round was mailed, which pretty much contained the same except for my EKG and some of the other stuff you got as well. I got a surgical report which went into detail of how the surgery was done and the findings, etc., and also the receipt with each doctor involved and the cost for each service. Is that what you got? I am so hoping my insurance gets really generous and will give me some reimbursement before the holidays. ; )

OK EVERYONE!! NEEDING LOTS OF PRAYERS HERE PLEASE AND PRETTY PLEASE! NOT ONLY AM I PRAYING FOR ALL OF YOU, I COULD USE SOME PRAYER POWER AS WELL. :))

I am not asking for prayer for money for Christmas. It will help with that, but also my family is in big financial binds lately and I want to help out my mom and brothers as well as pay some bills of my own and fix my car. :) Plus maybe have enough to put aside for a fill trip to TJ! ;)

Peace and many THANK YOU'S!

Judy

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Hmmm...I wonder if you got the same thing I did, but mine was faxed to my work and also the second round was mailed, which pretty much contained the same except for my EKG and some of the other stuff you got as well. I got a surgical report which went into detail of how the surgery was done and the findings, etc., and also the receipt with each doctor involved and the cost for each service. Is that what you got? I am so hoping my insurance gets really generous and will give me some reimbursement before the holidays. ; )

OK EVERYONE!! NEEDING LOTS OF PRAYERS HERE PLEASE AND PRETTY PLEASE! NOT ONLY AM I PRAYING FOR ALL OF YOU, I COULD USE SOME PRAYER POWER AS WELL. :))

I am not asking for prayer for money for Christmas. It will help with that, but also my family is in big financial binds lately and I want to help out my mom and brothers as well as pay some bills of my own and fix my car. :) Plus maybe have enough to put aside for a fill trip to TJ! ;)

Peace and many THANK YOU'S!

Judy

Oddly I did NOT get any breakdown for the cost :( I'm not sure if I'll need that or not since BCBS will pay whatever they consider "fair" payment for the procedure, if they pay. I'll wait to bother Rene again if I have to ;)

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Hi All, well BCBS DID reimburse me $800!, I was wishing for so much more but i guess i cant complain. In order to get any more reimbursed to me i have to show documentation that i have been obese for the past 5 years and have been treated for this by my primary doctor, and also have a BMI of 35 with comorbidities, or a BMI of 40 without comorbidities. Either way it doesnt really matter, my BMI was only like 35 and no comorbidities. And, I never went to the doctor for my obesity, I just couldnt afford it at the time, being a fulltime student and having to pay out of pocket for all my visits for REAL issues and all. So, good luck to all who are hoping to be reimbursed, Im rooting for you!

Oddly I did NOT get any breakdown for the cost :( I'm not sure if I'll need that or not since BCBS will pay whatever they consider "fair" payment for the procedure, if they pay. I'll wait to bother Rene again if I have to ;)
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