Removal of band covered but nothing else...need advise

evcase · April 17, 2007

OK, just found out (again..long story, short) my removal of band will be covered because it is "medically necessary"..however, insurance will only pay up to $2,000 for sleeve, repair, etc. as anything BUT removal is considered obesity-related and "they don't cover obesity-related" surgeries.

So, my question to my doctors office (they haven't called me back yet) is...since you are in there anyway removing the band and all the surgery staff is around, and ready and willing, can the dr just repair, insert new one or do the sleeve surgery. I mean, my gosh, how much more can that cost. They are in there anyway!!!

I seem to remember reading, and cannot locate right now, some advise on getting doctor to do additional work while in there. I need the procedure to be coded "medically necessary"...to be covered at 80%. Any ideas of what I can ask my dr to do?

I cannot pay out of pocket.

lightnerbride · April 21, 2007

Doesn't insurance suck! They would only cover to have mine removed not even to have it just repositioned. I ended up going to TJ, Mexico to have my second one put in.

It sounds like you need to see how much the surgeon would charge you for the extra time, anesthesia, etc to just slip the new band in. The surgeon may be willing to do it if you pay for the time difference that adding a band would take. It's not only the surgeons time though, usually the surgical room, the surgical nurses, the anesthesiologist and so on. That being said I'd bring up to your surgeon that it should only take about 15 minutes to put the band on and secure the port. You'll already be preped for surgery, under anesthesia, cut open and so it's just one more small step to add in the band and then finish up just like he'd have to do anyway. It doesn't hurt to ask!

Best of luck to you!