Question:
Has anyone needed another surgery and had them both done
at the same time so the insurance would pay for operating room and anesthesia (sp). I need a lap to check for endometriosis (sp) which is pretty simple surgery but I still need to be put out for it. What I wanted toknow is if my surgeon could do both and them bill my insurance for O.R. and anes. and I would pay the differnce for WLS. My insurance had denied me twice even after an appeal by Wlater Lindstrom. Any input would be great. Thank You Becky — becky M. (posted on February 9, 2004)
February 9, 2004
Yes, they can. When my doctor did my WLS he took out the gallbadder (which
is a seperate 'operation') he also found an ovarian cyst at the time, and
removed that (didnt know I had that). In my pre op papers, the doctor said
if you needed a hysterectomy or something else, to let him know.
How the insurance works normally is they 'pay' for the 'first' operation
and if the sugeon does something else - i.e a second while in their, its
'billed' its paid 'half'. Plastic surgeons do it all the time. The
insurance may pay for the Breasts and NOT the arms, and the doctor does
both at the same time. ONE thing I could as a 'problem' is JUST cause your
doctor wants to do yoru WLS 'lap' doesnt mean it will 'stay' lap... and if
your admitted in the hospital then the insurance wouldnt cover it. Also,
you would need to check with walter.. if you go ahead and basically 'self'
pay - IF you were to have complications later and still be under the same
insurance company would they pay? I would check carefully.... you cant
quarantee you will have no problems and if you did without insurance what
would happen?
— star .
February 9, 2004
I have heard that some surgeons will do this. In my case, I was surprised
that my bariatric surgeon would not do my gyn surgery - even though he's a
general surgeon. My other options were to have my gyn come and do it at
the same time (not an option, since he doesn't practice at that hospital)
or have another gyn do it (not worth the hassle). I'm getting the second
surgey done next month. I didn't push because in both cases, my procedures
were covered. I thought it was odd that my surgeon would NOT do it - but
others do, so definately something to discuss with your doctor. Best of
luck to you!
— w8free
February 9, 2004
I wanted to have my tubes tied while I had WLS and my doc said no. He
explained that WLS is very major surgery and when it is done lap, the
incisions are placed at precise places for what they are working on and
they would not be in the proper placement for a secondary surgery. He did
say that something like gallbladder could be done in the same area. He
also said that if there were complications or pain, it would be harder to
tell which surgery caused the pain.
— saltybichon
February 9, 2004
I had my tubes tied (covered by insurance) and a modified brachioplasty
(not covered by insurance). I was given a price break on the surgery room
and anesthesia. For example, it normally would cost $3000 for the surgery
room, but I only paid $1100. The anesthesia would normally be $1100 but I
only paid $850. Once your in there for the covered procedure, they've
already got you in the room and prepped and under the anesthesia so I think
that's why you get the price break.
— Patty H.
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