If your insurance doesn't cover WLS - will it cover complications?
I have so many questions. Thinking of sleeve - have to self-pay as insurance does not cover WLS (and yes I have appealed) but what I am wondering and afraid to ask insurance company (don't want to tip them off to me having WLS just in case) is - if down the road I have complications (anytime after being discharged from hospital after WLS) - will they cover me for those complications - meaning hospital charges, dr's fees, etc.
I am concerned If I have any complications - the insurance won't cover the charges and I certainly can't afford any huge hospital bills.
Anyone have an answer??
I am concerned If I have any complications - the insurance won't cover the charges and I certainly can't afford any huge hospital bills.
Anyone have an answer??
Yes, major medical coverage should cover complications that are secondary to the primary surgery. For example, if your insurance does not cover pregnancy but you end up with an intrauterine infection post-delivery, you are covered. Plastic surgery may not be covered, but a staph infection around your incision would be.
Who told you no? the insurance company? If you have a problem now - something connected to the surgery - suture rupture, hernia, or anything that is caused by having had the stomach partially removed - what will you do - cover it yourself? Just trying to cover all the possibilities before I have this surgery.
It is not covered. But, you can buy BLISS insurance. At Swedish Hospital in Seattle it is $2,000, and that covers all costs for complications for 18 months after surgery. Well worth it.
You can also buy a shorter term, such as 1 year to save money.
The cost of it depends on the hospital you use. Some hospitals have it included in the cost.
You can also buy a shorter term, such as 1 year to save money.
The cost of it depends on the hospital you use. Some hospitals have it included in the cost.
HW: 318.6 Pre-surgery Weight: 268.6 CW: 149 Sleeve Date: March 19, 2012
- 169.6 pounds! Doctor established medical goal weight = 165. I lost 50 pounds before getting sleeved. Current BMI = 27 Original starting BMI = `58.3 Tummy Tuck: 01-04-13
My insurance did not cover it. But, I consider it an investment in my health and life. No regrets about paying for it.
HW: 318.6 Pre-surgery Weight: 268.6 CW: 149 Sleeve Date: March 19, 2012
- 169.6 pounds! Doctor established medical goal weight = 165. I lost 50 pounds before getting sleeved. Current BMI = 27 Original starting BMI = `58.3 Tummy Tuck: 01-04-13
This was my fear, too. My husband's insurance does not cover wls. So I called them and asked this specific question--if there were complications-would that be covered? The customer service rep told me that he's seen it go both ways. He has seen claims denied because the initial surgery (he gave breast augmentation as an ex) was not covered. But then he has seen claims go through without any problem. So he didn't have a definitive answer for me. Now my surgeon did tell me that if I had dehydration post-op (for ex), then ins. would cover it because that would be an issue in and of itself.
It kind of freaks me out, though, so I am waiting to have wls until I can switch to my employer's health plan (which does cover wls). I just couldn't afford any huge hospital bills if something didn't go right.
Best of luck to you!
It kind of freaks me out, though, so I am waiting to have wls until I can switch to my employer's health plan (which does cover wls). I just couldn't afford any huge hospital bills if something didn't go right.
Best of luck to you!
"B" bears' mama from Texas
Follow my journey on youtube: "bbearsmama"
SW: 210 CW: 123.6
Most problems happen early on, not later.
Also, life has no guarantees. No one is guarenteed a job, or even health insurance years down the road... in this economy.
I think it is good to put your fears aside... and do what is best for your health.
Also, life has no guarantees. No one is guarenteed a job, or even health insurance years down the road... in this economy.
I think it is good to put your fears aside... and do what is best for your health.
HW: 318.6 Pre-surgery Weight: 268.6 CW: 149 Sleeve Date: March 19, 2012
- 169.6 pounds! Doctor established medical goal weight = 165. I lost 50 pounds before getting sleeved. Current BMI = 27 Original starting BMI = `58.3 Tummy Tuck: 01-04-13
From a claims perspective, it all depends on how it's coded. If there is an exclusion for said procedure, be it bariatric surgery, or anything else, anything pertaining to that excluded procedure can and more than likely will be denied coverage.
Many who self-pay, go through their PCM for follow up labs, medications etc etc, and it's not coded as part of their surgery. Labs are pulled as part of their annual exam/physical. Of course, this is something that needs to be discussed with your PCM and make sure they are familiar with which labs need to be pulled if you do not plan on continuing with your surgeon. Some surgeons/programs, offer an all inclusive pricing. A flat rate for self-pay patients that include X amount of nut visits, X amount of labs drawn, and etc etc.
Many who self-pay, go through their PCM for follow up labs, medications etc etc, and it's not coded as part of their surgery. Labs are pulled as part of their annual exam/physical. Of course, this is something that needs to be discussed with your PCM and make sure they are familiar with which labs need to be pulled if you do not plan on continuing with your surgeon. Some surgeons/programs, offer an all inclusive pricing. A flat rate for self-pay patients that include X amount of nut visits, X amount of labs drawn, and etc etc.
Band to VSG revision: June 3, 2009
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs
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