Self -pay - but if complications down the road - will insurance pay?

 Hoping to have WLS - self-pay - wondering if 1-2-3 years down the road - there is a problem that is due to having WLS - will my insurance cover it?  Any self-pays out there that have an answer for me?

This is a hard question to answer as medical insurance is so subjective as each employer group plan has their own directives.

In my experience, most plans have a two year pre-existing clause, if there is one at all, but the only way to know for certain is to read your particular plan and, if you still have questions, get on the phone to the insurance group and discuss.

 Group insurance through your employer usually doesnt have a pre-ex clause. Individual insurance often does. However, this would have no impact on the question asked unless the bariatric surgery was done prior to the issuance of an individual insurance policy and the complication occurred within the first two years after the effective date. Also, even if this is the case, an insurance company would have a hard time standing on a defense that the condition was pre-existing if the actual problem (complication) started after the effective date. 

 
With a lap band you WILL have problems down the road and if your ins excludes anything WLS related, welcome to self pay again.

Why not get a safer surgery type long term with no maintenance and very little chance of anything happening?  Did you know that according to Allergans website 88% will have band complications?

I double dawg dare you to meet 5 people 10 years post op with a band and still happy.  In six years of posting, I've met one.

Also keep in mind that policies can change from year to year. It may cover complications now, but maybe not in the future, or vice versa. I have been hearing about some doctors who offer "aftercare insurance". Ask your surgeon about it. Good luck on your journey!

I can only speak from experience: I have three good friends with bands; one was self pay. The self pay lady has had TONS of problems keeping anything other than slider foods down; she never lost more than 25 pounds and then gained that and MORE back. She wants her band removed by insurance will not pay and as she is currently out of work and back in college she does not have the funds to do so herself so she basically eats what she can and deals with it.

Another one of my friends had a port issue; since her insurance paid for the installation they also paid for the fix. She is not at her goal weight but lost about 70 pounds and is content, since the weight loss helps with her chronic pain issues and diabetes. Of course, she would like to lose more but with her many health issues was not really a candidate for bypass or DS.

The third: last I heard she was content with her band, although at that time she was not "at goal". She was close enough that she had a TT and breast lift, though. We have lost touch in the last three years so I have no idea if she had problems.

HTH and good luck.

You need to talk to your insurance company and find out how they treat the various things that can happen to you.

Mine wouldn't pay for WLS but they paid for all my pre-op esting and all my labs since and my ER visit at 7 weeks out. But I had a sleeve and when I talked to them pre-op they were adamant that they would not pay to remove a band or for any band complications. But with a sleeve, they would consider anything that happened to you as an accident.

I'm not sure why the differnece but I think part of it is that many of the complications you can have post-op can be had by anyone at any time and you can't really *prove* it's the WLS that did it. These include:

-blood clots (had one in '80 myself and not from surgery)
-bowel obstructions
-hernias
-dehydration
-kidney stones
-gallbladder problems (I lost mine in '89, still not from sugery)

Things like a stricture or a leak could be more easily tied back to the surgery but my insurance company told me that they'd pay to fix a leak if I got a sleeve.

It's one of those things in life that isn't black & white and where you are taking a risk but it was worth it to me and it turned out just fine.

 Nope, not if you have a weightloss exclusion. My insurance didn't cover my band going in and they will not cover it coming out..... On Tuesday!!! This has been a very expensive lesson... I could've had a personal cook and trainer for what I've spent on thus piece of crap. 

I take it that you have the band and are revising to something else and doing it self pay? Looks like you had the band in '04? My huuby's ins. told me they would not cover me for complications so I maintain my own isurance which is also the one that paid for my DS. But they(his ins.) do cover incidental expenses related to my DS as the secondary insurance, so I don't quite get it. Insurance is a complicated mess, all you can do is call and ask.
-Wanda

I had the lap band and revised to RNY this last November.  Insurance paid for all the fees with regards to the lap band insertion and removal and maintenance. I negotiated a cash price for the RNY. I have needed 4 EGDs with dilatations and insurance has paid for all of them, no questions asked.They also paid for my labs at 3 months.  I have insurance through my employer.