Will insurance cover post op complications for self payers?

[Rommy 7]

Hello all. I am self paying my sleeve surgery. The price I was quoted covers follow up visits, but if there are complications they are not included in self pay price. Does anyone know if health insurance would cover those costs when the original surgery did not go through them?

[freddie8_8 37]

Need to look at the exclusions section of your detailed health plan and see if complications from elective surgery are covered. Some cover and some do not.

[JamieLogical 8,727]

You should call your insurance company. Some policies will cover post-op complications and others will not.

[alakins246 6]

I called my insurance company today "global health" and they said they would NOT cover elective surgery post-op complications.????

[freddie8_8 37]

I had to correct my insurance company on the phone when the rep misread my policy. It is best to read the wording in the detailed exclusion section. Some policies are silent on coverage so you may need to act as your own advocate.

[Sharon1964 2,530]

Find out their definition of "elective". Just because they exclude the surgery from coverage doesn't mean it's elective.

[Kindle 8,667]

Read the details and fine print of your policy. They are all different when it comes to elective and WLS procedures. Mine SPECIFICALLY excludes WLS including postop complications from WLS unless it is for a "life saving procedure". So I assumed anything short of a life flight to a hospital in order to have emergency surgery for a severe leak would fall under not covered. Didn't matter if the original surgery was done in US or abroad. That was one of the deciding factors for me to go with a top notch, world-renown, "expensive" Mexico surgeon rather than a "cheap" US one. A complication would have financially destroyed me.

As for routine postop bloodwork, my PCP coded it under annual wellness checkup and insurance paid for the first one, but not the second and third because they were too soon after the 1st one to be considered annual wellness.

[Rommy 7]

Thank you all for your responses. I really appreciate it. After speaking with my insurance and reading the policy, it seems like they would not cover complications. I don't think I can expose my family to this kind of financial risk no matter how remote. I'll have to call my doc tomorrow and see what the options are. Feeling very disappointed.