Does Insurance Cover Fills After Self Pay?

[change4life10 1]

I was considering self pay and my husband and I were wondering if the insurance would ever cover the fills or if there is problems with the band down the road. I didn't know if it was something they would consider pre exsisting and not cover it for a period of time or if they would never cover it. I have BCBS of IL if anyone knows. Thanks.

[sman342 13]

My guess is that the exclusion is "obesity related services" so fills are not likely to be covered. You can get the fill medical code from your DR and find out if insurance covers it. I think my fills will cost $150-200. I havent had one yet but am also a self pay. Insurance has covered my other visits but they weren't directly related to gastric banding (physician physical, psych eval).

[sleepyone405 13]

BCBS of IL approved and paid for my surgery. However, your policy may be different. I would call their customer service line, since they have your policy and can tell you if it would be. I would think they would be covered, just as if something went wrong and they had to do surgery to remove or correct a problem, even if they wouldn't pay for the lapband originally, because it would then be a medical necessity. Of course, I'm an optimist. Call them though to be sure.

[highland 168]

As a self pay patient my first year of monthly visits and fills were covered by the fee I paid up front for surgery. My insurance will not pay for any fills or anything related to the band. I have the clause which states they will not pay for any "obesity related services" on my policy.

[bandbun 9]

I think getting all the fills covered in your self pay costs up front is an excellent idea ...

[highland 168]

It really is nice. It seems like many who are not successful with the band also do not follow the protocol for monthly office visits during that all important first year. I assume this is because of the i flated costs many of these surgeons charge for office visits that include fills.

[Winteranne 5]

I too was considering self pay, but was told by my insurance company (federal bc/bs of Florida) that they would not cover any fills if I went self pay. I ended up getting approved by insurance for my surgery and was told my copay for fills will be $50 vs. $150 if I had gone self pay. The insurance process has taken a little over 4 months, but definitely worth it for the money I have and will be saving. I know every situation is different, but I hope this helped a little.

Good Luck on Your Journey

[fire_bellydancer 2]

I was self-pay for almost a year (after losing my insurance. Aetna PPO covered my surgery in 2010) and now I have insurance again (United Healthcare PPO). My insurance company will pay for my fills, even though they didn't pay for my insurance. I have it in writing from them! But, my money hungry surgeon...has decided that once you are self-pay, you cannot use your insurance. What a load! I guess he prefers the $!50 that he would get from me as opposed to the contracted rate that he would receive from United. He is a preferred provider for United. Absurd!

[♕ajtexas♕ 3,771]

I was self-pay for almost a year (after losing my insurance. Aetna PPO covered my surgery in 2010) and now I have insurance again (United Healthcare PPO). My insurance company will pay for my fills' date=' even though they didn't pay for my insurance. I have it in writing from them! But, my money hungry surgeon...has decided that once you are self-pay, you cannot use your insurance. What a load! I guess he prefers the !50 that he would get from me as opposed to the contracted rate that he would receive from United. He is a preferred provider for United. Absurd![/quote']

Talk to UHC. If the doctor is a provider he is contracted to take the insurance. He doesn't have a choice.