Interesting Comment made on Dr. Oz show yesterday re: Insurance

[slm2007 7]

I thought this was quite interesting yesterday in the Dr. Oz interview. The one woman said that most insurance companies only pay for one bariatric surgery so if you need a removal/replacement, you are own your own. Is this accurate?

I often wondered if we needed it removed, how difficult it would be through the insurance company AND, if it was erosion or something like that and you were successful on it....would they replace it or would you have to do the whole pre-approval process again?

From what I'm gathering from her comments, if there are issues with it, if you need it removed from slippage, erosion, intolerance, whatever, since it is "bariatric" surgery, they will not pay for a second surgery and this would be self pay problem? I'm wonder because if it is erosion, that would be a sort of medical emergency, right?

Thoughts?

[Sue Magoo 71]

I had the old, small band. I had a slip and got a newer band with insurance coverage. The first band was July 2007 and second band was July 2010.

Sue

[Noturningback15 45]

I heard that as well and was thinking that's not accurate....the part about if you are not happy with it was true but if you are having serious medical problems or it's been a few years and you have not lost any weight they will pay for it to be removed.

[spoiltmom 44]

My plan will pay for any problems/ revisions as long as it's medically necessary.

[HeatherinCA 10]

I think it depends on your insurance company.. I don't know though.

Yea like Spoilitmom said, if you just want it removed... i doubt that will be covered.

[ElfiePoo 109]

Depends on the insurance company. I had my band out 2 weeks ago due to constant phrenic nerve pain. However, it never did anything to restrict how much I could eat and was not consistent about controlling the hunger and this was documented in my monthly visits to my surgeon's office. As a result, the insurance company sees this as band failure (even if there had been no phrenic pain) and is willing to do the revision to the sleeve.

When I went to the seminar I knew the band would not last for life and that there were a high percentage of complications where the the band had to be removed/replaced. So I asked the surgeon whether insurance would pay for it. Obviously, he said he couldn't give a definite answer, but the insurance person sitting in on the seminar said they'd never had a refusal by the insurance company to replace a band due to complications since this wasn't considered a second surgery, but rather a continuation/correction of the first.

They also never had a refusal to pay for a revision to sleeve or bypass from band as long as it was documented that the person put forth effort into working the band and it was more band failure than the person's refusal to make changes.

.

[emjay 8]

Depends on the insurance company. I had my band out 2 weeks ago due to constant phrenic nerve pain. However, it never did anything to restrict how much I could eat and was not consistent about controlling the hunger and this was documented in my monthly visits to my surgeon's office. As a result, the insurance company sees this as band failure (even if there had been no phrenic pain) and is willing to do the revision to the sleeve.

When I went to the seminar I knew the band would not last for life and that there were a high percentage of complications where the the band had to be removed/replaced. So I asked the surgeon whether insurance would pay for it. Obviously, he said he couldn't give a definite answer, but the insurance person sitting in on the seminar said they'd never had a refusal by the insurance company to replace a band due to complications since this wasn't considered a second surgery, but rather a continuation/correction of the first.

They also never had a refusal to pay for a revision to sleeve or bypass from band as long as it was documented that the person put forth effort into working the band and it was more band failure than the person's refusal to make changes.

.

Sorry to hear that you lost your band ElfiePoo. I haven't been on here lately so I've kind of lost touch with what's going on. Hope your revision goes well. Keep us posted on how your sleeve works out. I know if I ever have issues with the band that can't be resolved I'll need something else to keep me in check, either gastric plication or sleeve.

[Rainydayz 3]

My insurance plan specifically says they will cover repair or replacement for a defective or slipped or eroded band. After two years they will cover another surgery if adequate weight loss is not achieved despite following the drs. plan. To rest your mind I would call the insurance and ask them specifically.