Question about ongoing insurance coverage for RNY complications

chassibi
on 11/16/16 2:59 am

I expect to receive at least one if not 2 job offers in the next week. 

When considering these I need to take into account insurance coverage (I think). 

So if a policy has bariatric surgery as an exclusion, that means that the policy would not pay for any complications arising from my RNY, correct? That's my understanding, someone please correct me if I'm wrong. 

Thanks! 

Consult Weight:276/Surgery Day Weight: 241.6 /Goal Weight: 150

Patty R.
on 11/16/16 5:43 am - Harrisville, RI
RNY on 09/08/16

I'm wondering if this fits into "pre existing conditions". You aren't looking for the actual wls procedure, but possible complications after the fact.????

H.A.L.A B.
on 11/16/16 6:03 am

Pretty much. 

But it may depend on how the doc would code it.  

I.e. most my lab work is codded properly. But one doc sent lab work with a code "post op. WLS" ..even though I am over 8 years Post op - the insurance refused to pay for it...so they charged my account for over 700.. Ouch. 

I need to pay attention to the code next time. 

Normal people get GB issues. Or hernia, or twisted guts or mineral deficiencies or other issues... 

And no doc can tell you at 100% certatty that I.e your low iron is due to RNY and not crazy heavy periods...or leaky gut..or ...other blood issues. I used to anemic before RNY.  Post op - it got worse for a while... But it got better long term.. 

 

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

chassibi
on 11/16/16 6:23 am

I can definitely see how any of the above issues could be coded differently, but for something that was a surgical thing: like I don't know--ulceration of the pouch, or maybe a twisted gut or something--I'm wondering if insurance would cover if RNY was an exclusion.

Consult Weight:276/Surgery Day Weight: 241.6 /Goal Weight: 150

Grim_Traveller
on 11/16/16 6:49 am
RNY on 08/21/12

I had an ulcer a year ago. It wasn't at any of the anastomoses, or somewhere directly connected to WLS. None of the doctors could tell me if it connected to WLS or not. Pretty much anything that can happen to a WLSer can happen to us. A revision surgery itself is the only clear outlier.

I think there are exceptions to everything, so I'm not sure there will be any kind of certainty.

6'3" tall, male.

Highest weight was 475. RNY on 08/21/12. Current weight: 198.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

H.A.L.A B.
on 11/16/16 10:33 am

What Grim said . Normal people get ulcers and twisted guts - due to hernia or adhesions. 

so it is up to the doc how he codes it. 

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

Insert Fitness
on 11/16/16 7:25 am

I forget sometimes how complicated healthcare can be for you all in the us. I had to call to update my travel insurance policy post op which was complicated enough. Good luck weighing your options!

RNY Sept 8, 2016

M1:23, M2 :18, M3 :11, M4 :19, M5: 13, M6: 12, M7: 17, M8: 11, M9: 11.5, M10: 13, M11: 10, M12: 10 M13 : 7.6, M14: 6.9, M15: 6.7

Instagram:InsertFitness

CJ On Orcas
on 11/16/16 1:17 pm
RNY on 09/09/16

Complicated and about to get much, much worse.

conazza
on 11/16/16 3:07 pm
RNY on 09/23/16

You're a 100% right about that. ð??"

Lap band: 2006. Revision to RNY 9/23/2016

8/2/17: Goal Reached: 135lbs. & 115lbs lost (5'3")

Pre-op: 250, SW 242, CW 125, GW 135

Pre-op: 9lb M1: 20lb M2: 11.5lb M3: 11.9 M4: 13.4 M5: 10.8 M6: 10.2 M7: 8.1 M8: 8.4 M9: 6.5 M10: 5.7 M11: 3.5 M12: 4.3

CJ On Orcas
on 11/16/16 3:11 pm
RNY on 09/09/16

I am SO grateful that I had surgery when I did.  No telling if it would have happened otherwise.  I just decided to push up my knee replacement so I can get it done before January 21...

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