Who pays for any complications?

[lisaky71 0]

Hi everyone..after lots and lots of research, I attended a seminar yesterday and I'm ready to take the plunge with the lap. However, as I was sitting there, something hit me like a ton of bricks! I am self pay and it's a big investment...I'm a teacher, divorced, with 3 kids so I don't have excess money laying around. But if for some reason, I have a complication and have to go into surgery (slip, erosion, etc) will my Humana insurance cover that? Thanks for any info! :w00t:

[TwilightLover83 0]

My first thought is no they won't cover it, if they don't cover the surgery. But if I were you, call your insurance company and inquire.

[kiz 1]

I agree with Twighlight, but it might be worth a check with your insurance to be sure. My doctor includes a short period of band insurance with Blis with his self-pay contract. We had the option of buying the insurance ourselves for longer coverage, but it was pretty pricey.

[Melinco 1]

While my insurance won't pay to put the lap band in, if I had complications, as long as it isn't coded as lap band surgery, then they'd pay for it. Hopefully it never happens!

Best bet is to read the policy exclusions and see if it specifically excludes both the surgery as well as any related complications. And, for additional comfort, call your member services # that is on the back of your ID card and ask.

[outside*looking*in 0]

lisaky - Do you know if your doctor has complication ins? One of the many reason I am going with the doc I have is because he has 1year complication coverage for anything that may go wrong with the band -even if it means another surgery-. I will not have to pay for anything the first year. The time can vary for different docs. It is not much but better than nothing.

There is also ins you can pay for on your own but when I asked my doc about it he says he would not waste $$$ on it. Of course, he has his salary and I have mine:laugh: to cover furture medical bills:ohmy:.

[Cocoabean 430]

Before my insurance started covering bands, they specified they would not cover complications. Also, remember with the one year coverage mentioned, slips and erosions can happen much farther out than that. Although a year is better than nothing.

Even now my coverage specifies it will not covere a second WLS. I get one shot at it. They will cover complications, but not a revision to RNY if I wanted it. Not sure if I were to need it because the band eroded or something. That is a fight to be had it if happens. (With a prayer that it does not!)

There was a recent thread of a bandster who had a slip at 13 months, that would be a pooper with that one year coverage, eh?

[xavier 153]

I'm no expert but this is my understanding ( I am also self pay). If you are sick from the complication, meaning something that needs to be treated for your well-being, they have to cover it. But if the port flips or you have a leak so you are fine but the band just doesnt work...not covered.

I hope i never have to find out...I'm savin' those pennies for PS!

[Cocoabean 430]

I'm no expert but this is my understanding ( I am also self pay). If you are sick from the complication, meaning something that needs to be treated for your well-being, they have to cover it. But if the port flips or you have a leak so you are fine but the band just doesnt work...not covered.

I hope i never have to find out...I'm savin' those pennies for PS!

You know, that rings a bell about treatment being covered if the complication treatment is medically needed (i.e. life threatening).

Shoot, my researching was over two years ago now. My memory isn't that good.

Sheesh! :frown:

[xavier 153]

Its like anything else where they dont place blame. If you have an infection from your lap band, they cover treating even though you 'brought it on yourself' by getting the band. Same as all the stupid things people do and end up hurting themselves like firecrackers blowing your fingers off. On the other hand the insurers are not in the biz of caring whether your band is functional or not.So as a self payer, I hope with all hope I never get a port flip or worse (prob very expensive) a band leak!

On the other (third!) hand I think if you have a good doc and you have a complication that was caused by something that wasnt done right...maybe they would cut your bill some slack!

[Cocoabean 430]

Its like anything else where they dont place blame. If you have an infection from your LAP-BAND®®, they cover treating even though you 'brought it on yourself' by getting the band. Same as all the stupid things people do and end up hurting themselves like firecrackers blowing your fingers off. On the other hand the insurers are not in the biz of caring whether your band is functional or not.So as a self payer, I hope with all hope I never get a port flip or worse (prob very expensive) a band leak!

On the other (third!) hand I think if you have a good doc and you have a complication that was caused by something that wasnt done right...maybe they would cut your bill some slack!

This all makes sense, and sounds reasonable. Which probably means the insurers are looking for ways out! :thumbup: What isn't reasonable is three hands! :smile2:

I did read a post here of someone who needs her band removed, her doc wants to revise to RNY. Insurance will pay for the removal as it is medically necessary. If she does the revision at the same time, her surgeon charges a revision fee of around $1100.00.

I know that my insurance specifically says it will not cover a second WLS procedure. I do wonder if my surgeon does something like this, though. If my band did -need- to come out, I'd want to revise to RNY or get a new band, and I'd want it at the same time...if the insurance will pay for the OR and the anesthesia--too cool!

I found that an interesting way of going about it.

[xavier 153]

$1100.00 would really be pennies for RNY. That is a major operation and a copay on good insurance could be that much.

[Corliss 0]

Hi everyone..after lots and lots of research, I attended a seminar yesterday and I'm ready to take the plunge with the lap. However, as I was sitting there, something hit me like a ton of bricks! I am self pay and it's a big investment...I'm a teacher, divorced, with 3 kids so I don't have excess money laying around. But if for some reason, I have a complication and have to go into surgery (slip, erosion, etc) will my Humana insurance cover that? Thanks for any info!

So are you sure you insurance will not pay for your band? I am self pay and have had complications with 2 different bands. Fortunately my insurance paid for emergenc surgery both times though it would not pay for the placement. It wll now however. Good luck to you.

Corlss

[blessedbyfour 0]

i was self pay and my band slipped. My insurance is paying for the revision. I have Aetna. Hope that helps

[slojo67 125]

I'm having surgery with dr. almanza-reyes in Mexico, in august, he has a 300.00 policy which covers ANY complications, including airline flights, motel rooms etc, for 6 months. For 500.00 it covers you for a year. I'm doing the year policy... Just in case...

[Cocoabean 430]

I'm having surgery with dr. almanza-reyes in Mexico, in august, he has a 300.00 policy which covers ANY complications, including airline flights, motel rooms etc, for 6 months. For 500.00 it covers you for a year. I'm doing the year policy... Just in case...

I would, too, I think..just for peace of mind.