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INSURANCE COVERAGE -- THANK YOU OCC!!!


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MY INSURANCE PAID TOO!!!!!!! YAY!!!!!!!!!! =D>

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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!

Hi Katie,

Congrats on some reimbursement from BC/BS! Are you going to appeal for more? I would. I know $800 is alot, but not enough compared to what you actually pay out for the whole process. ; )

Just had a question about which BC/BS you have? I have Regence BC/BS PPO. There is an exclusion in my benenfits for anything related to obesity or weight loss, but still holding onto hope and alot of prayer. :) I will surely appeal if all goes sour.

Peace,

Judy

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I have BCBSIL PPO, I think i will apeal. I knew going into this that there were stipulations to bariatric surgery, so im willing to do what i can to get more. I knew that i would not qualify here in the states so i took the chance and paid out of pocket. So anything i get back is a plus. I hope all works out for you and you get as much reimbursed as you can. Keep me informed.

Hi Katie,

Congrats on some reimbursement from BC/BS! Are you going to appeal for more? I would. I know $800 is alot, but not enough compared to what you actually pay out for the whole process. ; )

Just had a question about which BC/BS you have? I have Regence BC/BS PPO. There is an exclusion in my benenfits for anything related to obesity or weight loss, but still holding onto hope and alot of prayer. :) I will surely appeal if all goes sour.

Peace,

Judy

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i owe you all a huge thank you!! i had my surgery on 11-02-06 and never even thought to file with insurance because it states everywhere that all bariatric surgery is excluded... well, i decided what the heck let me try anyways and it worked!! i just found out they are going to reimburse me $6800 of the $8500 i submitted!!! i am thrilled to say the least.

i have BCBS of CA so anyone out there that had surgery in 2006 - its not too late... file anyways just to see what happens!!

thanks you guys!!

kym

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Awesome Kim! What insurance do you have? How much did they reimburse if I may ask? I want to be able to yell it out too soon about reimbursement! LOL

Peace,

Judy

I was reimburesed $5500, but my DH's ins is called "in-house", so it's not an outside insurance. I was surprised they covered it, but very pleased!!

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i owe you all a huge thank you!! i had my surgery on 11-02-06 and never even thought to file with insurance because it states everywhere that all bariatric surgery is excluded... well, i decided what the heck let me try anyways and it worked!! i just found out they are going to reimburse me $6800 of the $8500 i submitted!!! i am thrilled to say the least.

i have BCBS of CA so anyone out there that had surgery in 2006 - its not too late... file anyways just to see what happens!!

thanks you guys!!

kym

So they specifically exclude bariatric surgery, but are agreeing to reimburse? Odd, but congratulations!

I have UHC Choice PPO. All obesity surgery excluded including for morbid obesity. Non-emergent care received outside of the US is also not covered.

I see no upshot in filing. In fact, I am a bit worried that if they knew I had the surgery, they would exclude complications from WLS.

But, again, congrats to all that have been able to get some reimbursement!

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I have BC/BS in PA. They just started covering LapBand in Jan.07. I had to work with the Dr., follow a physicians diet for six months and have at least one comorbidity (I was diagnosed with insulin resistance in Dec. 06). My surgery was October 10. I have not paid for anything so far except $25 co-pay everytime I saw the Dr.

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Greg,

i too was worried about the insurance company finding out about the surgery outside and that they might drop me but so far they are still covering me thru my family doctor and havent said anything about it.... my BCBS of CA booklet clearly states that all obesity surgery is excluded so i really didnt expect a dime much less almost all of it paid. i even asked the BCBS rep last year when she was here if there were any exceptions and she said no they would not cover it at all... i dont know if i just got lucky or what but it is an answered prayer and it will pay off my loan of $225 a month that i had financed for years to come.

kym

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OK, faxed everything in. They know about my obesity problem and know I've been working on it for a few years. Plus Dr. Ortiz removed a hiatal hernia which I'm hoping they'll AT LEAST cover.

Couple of problems:

My form asked for a signature from the provider

And a breakdown of the amounts charged

I sent it in w/o both but with all my OCC paperwork. Has anyone been required to get a signature and financial breakdown? If so, were you able to get it? BCBSGA covers WLS so I'm hoping to get SOMETHING. And like I said, even though I have an absurd ($5K) deductible, with a new surgery coming up, even something towards my deductible would help.

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:angry: I am so upset right now. My insurance denied my claim. I am SOOOOOOOOOO going to appeal about this because I saved them thousands of dollars and should have been reimbursed for a good part of what I paid out of pocket. I understand there are exclusions about anything relating to weight loss and therefore appealing better work.y

Wish me luck!

Judy

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:angry: WELL THAT'S IT THEN. MY INSURANCE ABSOLUTELY WILL NOT COVER ANY BARIATRIC SURGERY BECAUSE THEY ARE BOUNDBY MY BENEFITS CONTRACT THAT THE EXLUSION IS AND EXCLUSION AND THAT' S IT. I HAVE BEEN EMAILING BACK AND FORTH WITH THEM AND THEY WILL NOT BUDGE. NO MATTER WHAT I SAY AND HOW BENEFICIAL TO MY HEALTH THIS HAS BEEN, FORGET ABOUT IT! PERIOD.

ONLY THING NOW IS I HOPE TO BE ABLE TO CLAIM IT ON MY TAXES. ANY SUGGESTIONS OR HELPFUL ADVICE THERE? IF YOU CAN AND SO ON?

JUDY

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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 had mine done Sept. 25. Insurance would not pay. I have Blue Cross Blue Shield Health Advantage. Does anyone know if you can fight them if they have a clause saying they will not cover any weight loss surgeries.

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:angry: WELL THAT'S IT THEN. MY INSURANCE ABSOLUTELY WILL NOT COVER ANY BARIATRIC SURGERY BECAUSE THEY ARE BOUNDBY MY BENEFITS CONTRACT THAT THE EXLUSION IS AND EXCLUSION AND THAT' S IT. I HAVE BEEN EMAILING BACK AND FORTH WITH THEM AND THEY WILL NOT BUDGE. NO MATTER WHAT I SAY AND HOW BENEFICIAL TO MY HEALTH THIS HAS BEEN, FORGET ABOUT IT! PERIOD.

ONLY THING NOW IS I HOPE TO BE ABLE TO CLAIM IT ON MY TAXES. ANY SUGGESTIONS OR HELPFUL ADVICE THERE? IF YOU CAN AND SO ON?

JUDY

JUDY I was self pay also as my insurance had the same clause. I am diabetic, high blood pressure and diabetes was not in control yet they still would not pay. Now that I have had it done and know how I feel I would go to be bank and borrow twice the amount I spent to have it done again. I would do just about anything to have it done. It has given me back my life. I did not realize how bad I felt before. I think I was on my way out of this world. I think my family knew and they encouraged me to go have it done. I did not care enough about myself to go do it I guess. I was afraid of being put to sleep also. Anyway, see it as a car payment, house payment, anything to go have it done. It is the best thing I have ever done for myself,

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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

Judy,

I got paid $6,250.00

MInnie : )

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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

Dawn,

I got money back $6,250.00. I am sooooo happy.

Minnie : )

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Way to go Minnie! Congrats! How did you do that? I thought you had exclusions in your insurance benefits too?!

Let me know k?

Thanks!

Judy

Hi Judy,

they paid for everything but the cost of the band itself. OCC sent me a break down of the cost and 2000 was the band cost. So $6500 minus my 250 deductable left me with 6250. I was so shocked and very greatful. So everyone should apply even if they say they don't cover weight loss surgery.

Minnie : )

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Hi Judy,

they paid for everything but the cost of the band itself. OCC sent me a break down of the cost and 2000 was the band cost. So $6500 minus my 250 deductable left me with 6250. I was so shocked and very greatful. So everyone should apply even if they say they don't cover weight loss surgery.

Minnie : )

Hi Minnie,

Didn't you have an exclusion too? I did and it was for anything and everything related to weight loss. I just don't know what to do now. I was told flat out, that they will not cover anything at all. They said in February they told me to get my doc to call the pre-authorization number at the insurance company, but I didn't because I felt I would still have to go through all the step by step appts. before getting banded and then what happens if they deny me then. I would be stuck with a huge bill. So, I got the same detailed surgical bill from OCC like you did and sent it to my insurance. They totally refused to pay up.

Judy

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Hi Minnie,

Didn't you have an exclusion too? I did and it was for anything and everything related to weight loss. I just don't know what to do now. I was told flat out, that they will not cover anything at all. They said in February they told me to get my doc to call the pre-authorization number at the insurance company, but I didn't because I felt I would still have to go through all the step by step appts. before getting banded and then what happens if they deny me then. I would be stuck with a huge bill. So, I got the same detailed surgical bill from OCC like you did and sent it to my insurance. They totally refused to pay up.

Judy

Judy,

sorry about that. Maybe you should try and submit just the hospital stay and all minus the lap band part and see what happens. Ask OCC for a modified report excluding the lap band. It won't hurt to try.

Minnie

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