Question for those that self pay and have insurance.

I've always wondered, if you decide to self pay for a wls procedure that your insurance will not cover, if you have compications related to that surgery 1 month out, 10 years out...do they help or are you just screwed?

In my case screwed.. so I opted only for a WLS surgery covered by my insurance.

Good Luck

Generally, you are responsible for all costs associated with the surgery -- if you paid to have it (because insurance would not pay for it), then you pay to maintain it, reverse it or revise it.

It appears that many insurance companys that DO pay for WLS are starting to LIMIT it to one procedure per lifetime --- so, even if your insurance paid, it may not pay to fix, replace or revise you.

I am OK. Some complications - that are due to exclusively the WLS:S - they probably would not cover. But everything else - since nobody can prove that the WLS caused that (i.e. hernia, GB removal, blood work test, another hernia repair, etc.) Insurance covered that all.
 
The question may be how the doc - in future complications will classified the "condition" as WLS  related - or not. 
But - any reconstructive surgery (skin removal, PS) was not covered. Also any problems with the WLS - they most likely would not cover.


 

 I self paid for my WLS. 

I have had 3 different insurances since this surgery, and all 3 have paid for issues that were related to the surgery. 

They pay for all labwork/blood draws, which I have regularly, and have been open with them as to why. I was told by my current insurance that they will ALWAYS cover lab work, and never have hoops to jump through like referrals or pre-approvals, like they often do for other things. They will always cover that stuff - period.

I have also had some issues that were suspected partial obstructions, that may or may not have been related to the WLS, and they covered them all regardless. Even knowing that I stated I had WLS and wanted the medial team to be aware so they could rule out anything necessary, the insurance has always paid regardless. 

I have always been up front about the WLS, since I feel it's necessary for the doctor to be fully informed, and not one of the 3 insurers has given me any flak. The 3 insurers are Group health, Molina, and Regence (Oh yeah, also Premera, which I think is actually BCBS). I have some real gripes about several of these companies, but covering issues relating to WLS is not among them.

My insurance company told me that, if I had a lapband and paid for it msyelf, they would not pay to have it taken out if it needed to come out. However, if I had some other WLS and had complications, they would most likely be covered. I had a sleeve and my insurance paid for:

1) All my pre-op testing except for the normal co-pays
2) The biopsy on my removed stomach (which they never should have, but I wasn't going to argue with them about it)
3) My ER visit from a kidney stone 7 weeks out from surgery
4) All my lab work that I had done at various times since surgery

It varies by insurance company and policy. In my case any care not provided under the CPT code of my surgery, but rather under other diagnoses, is covered.