I'm cash pay BUT...will my insurance cover other stuff post surgery?

[LightlyMyDarling 5]

My husband's insurance plan will not cover any bariatric surgery, even with co-morbities, so I am doing a cash pay VSG.

Does anyone have experience with insurance covering complications AFTER surgery, hospital stay, post op office visits, etc?

I mean, can insurance deny ANYTHING related to the surgery or just the surgery itself? I assume prescriptions will be covered so that's a plus at least.

[McButterpants 2,846]

I'm not clear on the complications thing - I think it depends on the complication (if it's directly related to the surgery like they need to go in to fix a leak, I think insurance won't cover). It's a good question to ask your insurance company or your surgeon's insurance coordinator.

I was self-pay and traveled out of the area for surgery - I have a local surgeon that agreed to do my follow up care.

As far as aftercare, my insurance doesn't cover anything weight loss related. They don't cover the follow up visits, for me those are $195 each (2 weeks, 6 weeks, 12 weeks, 6 months and then yearly). I have my primary care doctor order the labs - she knows to not code it as weight loss related, so insurance will cover it.

[justdream 15]

Does anyone have BCBS of NC Medicare Blue Advantage? I have my one more appt w/ PCP???? and have aced very required test and evaluations etc , I have a BMI of 39, 5'4 and weight 230, have had type two diabetes for seven years and on Lantus twice a day, high blood pressure and a dad and sister die in their thirty s from heart disease and type 2 diabetes my surgeon is convinced I will be approve and is not worried at all, I have my telling me that my surgeon knows who will be accepted before he ever starts the process,

[justdream 15]

And I am so scared I wont get approved , haven't heard from anyone with company an was wondering , does my BCBS make approval or does Medicare , my surgeon says Nov date for my sleeve, how can he say that and paper work o be filed until after PCP appointment , does my doctor really know that I'm approved or not before I start all the hoop jumping? I am just so scared of denial

Edited October 22, 2014 by justdream

[Forsythia 882]

Does anyone have BCBS of NC Medicare Blue Advantage? I have my one more appt w/ PCP and have aced very required test and evaluations etc , I have a BMI of 39, 5'4 and weight 230, have had type two diabetes for seven years and on Lantus twice a day, high blood pressure and a dad and sister die in their thirty s from heart disease and type 2 diabetes my surgeon is convinced I will be approve and is not worried at all, I have my telling me that my surgeon knows who will be accepted before he ever starts the process,

You will be fine. I had BCBS (of IL, but they all generally go by the same rules). BMI of 35 or higher with co-morbidities. High blood pressure and Type II diabetes will get approval.

[justdream 15]

Thank you, just need to hear it from others , so nervous .