paulafox Posted July 14, 2008 Report Share Posted July 14, 2008 Ok I have had my surgery but I am want to know if anyone has filed insurance? I have filed my insurance myself and now I am having to get procedure codes and such for my insurance, I have gotten some from the OCC but not all that I need, so I was wondering if anyone else has filed and had any luck? Link to comment Share on other sites More sharing options...
fat2nrml Posted July 14, 2008 Report Share Posted July 14, 2008 As a matter of fact, I just got a rejection notice from Hubby's insurance company. They don't cover any weight loss surgery so they won't reimburse me for any of the expense. I was hoping they'd at least give me the testing costs. They put a little reminder at the end of the notice stating that they don't cover having excess skin removed after weight loss either. Jerks! Good luck Paula, I wish you the best! Link to comment Share on other sites More sharing options...
Dolittle Posted July 14, 2008 Report Share Posted July 14, 2008 Ok I have had my surgery but I am want to know if anyone has filed insurance? I have filed my insurance myself and now I am having to get procedure codes and such for my insurance, I have gotten some from the OCC but not all that I need, so I was wondering if anyone else has filed and had any luck? Dealing with insurance providers is a major pain in the ass. First, you have to have WLS coverage in your plan. Then, most insurance requirements are that you have a BMI of 40 or above,, at least 2 co-morbidies and they want you to be on a 6 month doctor supervised diet. So,, they make it really tough to get approval. Their goal is for you to get tired of jumping through the hoops and they're hoping you give up. As far as paying for a tummy tuck,, no insurance provider pays for any cosmedic plastic surgery. They will pay for a tummy tuck if its a medical nessessity,, but that takes your family doctor and the plastic surgeon to calaborate and work the system for you. Good luck and hang in there. But,, If you don't have coverage,,, the OCC is the place to go if you have to pay out of pocket! Link to comment Share on other sites More sharing options...
paulafox Posted July 14, 2008 Author Report Share Posted July 14, 2008 I am thankful that my hubby's insurance will pay for 1/2 of the cost of my surgery. I have done all of the things that they ask you to do before hand because I was going to have it done here in the states until I found the OCC, and after looking and researching them changed my mind to have it done at the OCC !! I know that I had read on here where some had filed insurance claims but I could not remember who it was and getting the codes is murder! But I will just keep trying until I have everything that they need! Link to comment Share on other sites More sharing options...
CincyBanded Posted July 14, 2008 Report Share Posted July 14, 2008 Well, i work for a major health insurance company. first of all i can tell you that if your insurance company through work or your spouse's work denied you, it's more than likely not b/c they don't cover them at all. it's either b/c the company you are getting your insurance through has a rider on the insurance policy denying any weight loss surgery or that you don't meet the certain criteria that the insurance companies require. some make you go through a 12 week program for weight loss before you have the surgery. others make you do 6 months to a year worth of documented dieting with your personal physician. ok that's about all i had. sorry for the long winded post. lol Link to comment Share on other sites More sharing options...
fat2nrml Posted July 14, 2008 Report Share Posted July 14, 2008 Well, i work for a major health insurance company. first of all i can tell you that if your insurance company through work or your spouse's work denied you, it's more than likely not b/c they don't cover them at all. it's either b/c the company you are getting your insurance through has a rider on the insurance policy denying any weight loss surgery or that you don't meet the certain criteria that the insurance companies require. some make you go through a 12 week program for weight loss before you have the surgery. others make you do 6 months to a year worth of documented dieting with your personal physician. ok that's about all i had. sorry for the long winded post. lol So because of this rider, I'm screwed? Link to comment Share on other sites More sharing options...
jena Posted July 14, 2008 Report Share Posted July 14, 2008 So because of this rider, I'm screwed? Yep. The insurance companies don't tell your company what they are getting, your company tells the insurance company what they want covered. Link to comment Share on other sites More sharing options...
CincyBanded Posted July 15, 2008 Report Share Posted July 15, 2008 Yeah basically. If that company chooses not to cover any weight loss surgeries then they don't have to. The insurance company can't tell them that they have to. I see a lot of companies now that are putting this rider on their insurance b/c this surgery is getting so popular. Luckily the company I work for (Anthem) still allows us to do it and people that work here are getting them done at alarming rates so I'm sure it's costing them a fortune. I can see them in the next year or two taking it off of our insurance. I dunno though. Sorry for the bad news. Link to comment Share on other sites More sharing options...
mona-camille Posted July 15, 2008 Report Share Posted July 15, 2008 Dealing with insurance providers is a major pain in the ass. First, you have to have WLS coverage in your plan. Then, most insurance requirements are that you have a BMI of 40 or above,, at least 2 co-morbidies and they want you to be on a 6 month doctor supervised diet. So,, they make it really tough to get approval. Their goal is for you to get tired of jumping through the hoops and they're hoping you give up. As far as paying for a tummy tuck,, no insurance provider pays for any cosmedic plastic surgery. They will pay for a tummy tuck if its a medical nessessity,, but that takes your family doctor and the plastic surgeon to calaborate and work the system for you. Good luck and hang in there. But,, If you don't have coverage,,, the OCC is the place to go if you have to pay out of pocket! Uh, not quite accurate, my sisters insurance paid for her surgery and IS going to pay to have have her boobs lifted and a tummy tuck when she is done. Just a note - people are very misinformed about how insurance works. It is not the insuracce companies themselves that pick and choose what benefits are covered and what are not. It is the owner of the policy that decides that. In other words, if you have insurance through your work, it is your company that you work for that picks and chooses what things are covered. So, it isn't the insurance that decides, it is your employer. So, people mistakenly get mad at insurance companies when in fact, they have nothing to do with it. They are simply the ones administering your employers wishes. Also, there are an awful lot of rules and regulations that your individual states mandate. Usually, they are for the protection of it's people, but end up costing a massive amount of money to implement. I know this, because it is what I have been doing for the past 20 years. Another intersting note that most people don't know - Did you know that in NY, CT and NJ the state itself sets the medical insurance rates for groups, not the insurance companies. They are legally required to charge what the state mandates. And to top that off, it is usually MORE that what the insurance companies would have charged had they been left alone to decide their own rates. Sorry, for the rant, I just get very defensive about this. Link to comment Share on other sites More sharing options...
CincyBanded Posted July 15, 2008 Report Share Posted July 15, 2008 That's pretty much exactly what I said in my above post. I do get aggravated when some people think it's the insurance company instead of the employer who is carrying the insurance. But there are some times where it's the insurance company too. The insurance industry definitely isn't innocent with all of this either. lol Also, Anthem will pay for ONE tummy tuck but I have to wait for 2 years after my surgery has been complete before I get it. I guess that's to make sure I've lost pretty much all the weight I'm going to lose. Although they will not pay for any other cosmetic surgery b/c of the lap band. They will only pay for the tummy tuck and only one. So they are fairly cool about that. I mean they really don't have to pay for it but they do. Link to comment Share on other sites More sharing options...
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