Self-pay and post-op problems

[Ms.AntiBand 2,984]

If your insurance states they don't cover any wls then they don't cover any wls related complications either. Even if you code due to complications. They don't even have to pay if it's a medical necessity. My expenses hit $100,000 and insurance denied any coverage.

Check with your insurance company if you can't cover expenses from a possible complication. If you can afford it don't inform them at all or you'll be red flagged and they will scrutinize all your incoming medical billing.

[laffypatty 47]

If your insurance states they don't cover any wls then they don't cover any wls related complications either. Even if you code due to complications. They don't even have to pay if it's a medical necessity. My expenses hit 100' date='000 and insurance denied any coverage.

Check with your insurance company if you can't cover expenses from a possible complication. If you can afford it don't inform them at all or you'll be red flagged and they will scrutinize all your incoming medical billing.[/quote']

My insurance DOES cover WLS. I'm just not sure I'll be approved.

[Ms.AntiBand 2,984]

Oh sorry I misunderstood. I don't see how thy can deny coverage for complications then. Good luck

[JamiO 52]

I was self pay and part of the price I paid to my doctor covered insurance that would cover any complications up to 3 months after the surgery I believe.

[laffypatty 47]

I was self pay and part of the price I paid to my doctor covered insurance that would cover any complications up to 3 months after the surgery I believe.

That's good to know! Lets hope that's a standard for all bariatric surgeons.

[aliekat55 157]

Corky, my current BMI is almost 43. I have a 3-month-old baby. The weight I have for 2010 is while pregnant, my 2011 weight is at my 6-week postpartum checkup, and my weight for 2012 is while pregnant. Since my insurance paid for my pregnancies, they'll know the submitted weights are while pregnant. You catch my drift? Those weights all put me at a BMI of well over 40. My no pregnancy weight in 2010 and 2012 put me at a BMI of 35 and 37, respectively. My insurance requires a comorbidity if you have a BMI of less than 40. I have none. Looks like I'm screwed either way - unless, of course, the person reviewing my file doesn't pay attention to the fact I was pregnant in '10 and '12 or at least doesn't care...

Personally, with my experience with insurance companies, I dont think they have the capability of putting those bits of data together. They will look at your BMI, any chronic conditions and then either approve or try to deny depending on the insurance company. I think you timed it perfectly, unless of course you are planning to have another child soon.

alex

[laffypatty 47]

Personally' date=' with my experience with insurance companies, I dont think they have the capability of putting those bits of data together. They will look at your BMI, any chronic conditions and then either approve or try to deny depending on the insurance company. I think you timed it perfectly, unless of course you are planning to have another child soon.

alex[/quote']

Alex, I love your optimism and pray you're right. As far as I'm concerned, I don't plan on having any more children. Of course God may have other plans! LOL Two kids, two parents - at this point they don't outnumber us...

[pantala 125]

I did not qualify for covered WLS under my insurance plan (lowish BMI and no co-morbids) so according to three different conversations with the ins.co., complications for self-pay (they called it elective surgery) would not be covered either. Just for fun, I asked about non-covered plastic surgery complications and same deal: no coverage.

It's the biggest concern self-payers have.

[KatInFL 216]

Confirm with your insurance but if they deny your surgery, post op complications are also not covered.

This is not necessarily accurate. My insurance excluded WLS specifically, regardless of any circumstance. They do, however, cover emergency and follow up care, as necessary. If I had had an emergency post-op, they would have covered whatever care was needed.

It is a question I specifically asked. My PCP even helped me find a bariatric surgery practice that was willing to treat me, if I had any need, once I was home.

Luckily, it hasn't been an issue. But it eased my mind knowing I would be care for, should I need it.

~Kat

[mlecompte 20]

This is not necessarily accurate. My insurance excluded WLS specifically' date=' regardless of any circumstance. They do, however, cover emergency and follow up care, as necessary. If I had had an emergency post-op, they would have covered whatever care was needed.

It is a question I specifically asked. My PCP even helped me find a bariatric surgery practice that was willing to treat me, if I had any need, once I was home.

Luckily, it hasn't been an issue. But it eased my mind knowing I would be care for, should I need it.

~Kat[/quote']

Kat how did you go about figuring this out? I plan to be a self pay also because my insurance doesn't cover wls. I would like to know if they cover anything related to it afterwards.

[KatInFL 216]

Kat how did you go about figuring this out? I plan to be a self pay also because my insurance doesn't cover wls. I would like to know if they cover anything related to it afterwards.

I talked to my HR and they contacted the insurance company to clarify.

~Kat