Help! 1 weight loss surgery a lifetime> Band eroded
On January 6, 2011 at 10:51 PM Pacific Time, DianaCox wrote:
Uh, no -- LeaAnn had a lawyer. She (and I) provided a lot of the ground work information about the DS to the lawyer, but she did not -- and could not -- file and prosecute a federal lawsuit on her own. And one of the reasons she HAD to file an ERISA suit is that AL doesn't have a Dept. of Insurance to appeal to -- but most states do.And Walter, it IS law -- it is CONTRACT law. There is no law that requires insurance companies to cover WLS, even if there should be. So they can make any exclusions regarding more than one WLS that they want to.
So if the ins co has this contract law on their side, does the OP stand a chance with the one WLS in a lifetime policy?
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Probably not.
She stands a better chance if her insurance is self-funded -- if her employer actually pays the medical bills, and just pays the insurance company to administer the plan. In that case, if she pleads her case to her employer, and they FEEL LIKE helping her, they can decide to help her. But there is nothing that requires them to do so.
She stands a better chance if her insurance is self-funded -- if her employer actually pays the medical bills, and just pays the insurance company to administer the plan. In that case, if she pleads her case to her employer, and they FEEL LIKE helping her, they can decide to help her. But there is nothing that requires them to do so.
On January 7, 2011 at 7:40 AM Pacific Time, DianaCox wrote:
Probably not.She stands a better chance if her insurance is self-funded -- if her employer actually pays the medical bills, and just pays the insurance company to administer the plan. In that case, if she pleads her case to her employer, and they FEEL LIKE helping her, they can decide to help her. But there is nothing that requires them to do so.
Well, OP, there you go. This is coming from a lawyer that helps people get surgery pro bono.
Welcome to my world, the world of self pay.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The one WLS in a lifetime is legit and your ins does not have to pay. You can fight it but odds are you are self pay for a revision.
People are not choosing wisely for surgery and ins does not want to pay repeatedly for 2nd and 3rd revisions and they don't have to. They have the law on their side.
You can try, but you are not likely to win. :o(
Welcome to the world of self pay.
People are not choosing wisely for surgery and ins does not want to pay repeatedly for 2nd and 3rd revisions and they don't have to. They have the law on their side.
You can try, but you are not likely to win. :o(
Welcome to the world of self pay.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Walter Lindstrom is with Obesity Law at ObesityLaw.com . I used them and highly recommend them. They have a high success rate and these are the only kind of cases they work with, so are very experienced. They have an online form for you to fill out and Walter will contact you pretty quickly and give you an honest opinion about whether or not he thinks you can win. Good Luck.
http://www.obesityhelp.com/forums/amos/4067913/WARNING-TO-PR E-OPS-Think-twice-cut-once-or-else/
DianaCoxSan Jose, CA Robert Rabkin, M.D. Duodenal Switch (08/05/03) Member Since: 12/22/02 [Latest Posts] |
Post Date: 11/20/09 12:52 pm As someone who helps people get insurance coverage for the DS, I am also seeing more and more people looking for REVISIONS to their first bariatric surgeries which failed them -- almost always the VBG, VSG, Lapband or RNY. More and more often, people are showing up with a new contractual limitation in their health insurance which often turns out to be insurmountable: a one-bariatric-surgery-per-lifetime restriction. Yes, even if a different insurance company paid for your initial surgery, or even if you SELF-PAID for your first surgery. Basically, the insurance company is excluding ANY revision surgeries, except possibly to reverse the surgery altogether if there are medically necessary complications, e.g., to remove a bad band -- but they won't pay for a revision to another surgery. THINK TWICE, CUT ONCE -- YOU MAY NOT GET A SECOND CHANCE! Make sure you really understand the true benefits of the DS before you opt for a less-effective surgery. DSers: PAY IT FORWARD! High wt/current/post-recon goal: 293/169/160 |
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I hope you have success, but think it is unlikely. My insurance had that exclusion already 4 years ago. I had initially planned on the band or RNY, but after research and the fact of one procedure for a lifetime, I decided to go with the DS because it had the best long term outcome, and I was fortunate enough to have a surgeon right here that does them. My insurance will pay to fix something that goes wrong with a procedure, but will not pay for a second procedure if the first one is unsuccessful. There is a very remote possibility that you could get around it because the failure was due to the band erosion, not simply lack of success on your part. All you can do is try...Good Luck!
-Wanda
-Wanda
Highest -380 Surgery- 345 Goal- 150 Current-150 5 ft. 8 in.
Update.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
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