Insurance won't pay for complications

[ernurse12 0]

I just recieved my approval letter yesterday but in bold letters it said there is no coverage for complications related to the procedure/surgery. They pay up to 28,000.00 for the surgery itself but not complications. I was cautiously optimistic about the surgery before I got the letter but now I really frightened. I can't risk putting my family in financial ruins if there are complications and I have to pay out of pocket. I don't know exactly what they mean, what if I have complications while still in the hospital, does that count or do they mean afterwards, like months later. I'm kinda freakin out about it now. If they won't pay for problems later maybe they shouldn't cover this at all. How is it different than any other surgery with complications, other than its an elective surgery.

has anyone else has this issue and had to challange the insurance company. BTW, I have umr-iba

Thanks for letting me vent

[Alexandra 55]

I think this is just CYA language that they can't really enforce. Any insurance carrier is obligated to cover emergent care, so if you have a complication that really requires instant attention they would have to cover that. The alternative would be a lawsuit, and no carrier wants to go there.

However, they are within their rights to exclude coverage for some complications that might be seen as elective in their own right. The good news is that even the very worst complications of banding are easily handled, and won't bankrupt you. In the very worst case you would have to have surgery to have it removed--an operation that isn't likely to exceed $20,000.

On the other hand, I think it's a big concern that if you go into this thinking that your insurer won't cover anything, you might be inclined to ignore symptoms you shouldn't ignore. And that's the path to big complications. Successful banding requires close attention and if you don't think you can get the care you will need this could be a problem.

[valzie 0]

I don't see how they cant pay for complications especially if it is affecting your health.

[mylapspirit 2]

ERnurse,

My approval letter stated that the only complications they would not pay for would be if I was not compliant with the medical instructions given to me after the surgery. I kind of read into this that means if I don't stick with the postop diet and then something happens like slippage, etc. Could this be your situation too? I feel all the more reason to stick to the bandster rules after the surgery. What a great motivator. Good luck in your weight loss journey. I hope that letter doesn't stop you from pursuing a band life.

Michelle:ranger:

[ernurse12 0]

Monday I'm going to call the insurance with more questions and get things in writing. Because I'm a nurse I see the worst of things sometimes and I know how expensive hospital costs can be, but your right Alexandra the best prevention is early treatment, I guess I'll have to let the Dr. do the diagnosing and not diagnose myself.