Band Slipped - Insurance Denied Coverage

LJBravado · September 15, 2007

:help: So I have known all along that my health insurance company does not cover lap-banding, or appointments that go along with it, i.e., fills.

I'm sorry to say that I had a slip - and a bad one, this week and ended up in the ER. I was then admitted to the hospital where they did emergency surgery and re-positioned my band back to where it's supposed to be. Thank God everything went great and they didn't have to remove or replace my band, and I was able to come home Friday.

My insurance company has completely denied the claim, and although I realized that this could happen, I do wonder if anyone has had this experience and appealed with any success based on the fact that, while the lap-band itself is an elective surgery, the repositioning was an emergency situation that they might at least cover part of? This also makes me wonder if a person has a tummy-tuck or other cosmetic surgery, do insurance companies also deny any illnesses or issues that arise due to these elective surgeries? Are there additional insurance policies that a person should take out to cover these things?

Finally, has anyone had the band repositioned and paid out of pocket? What was your cost?

Thanks to all for your input. On one hand I accept full responsibility for the surgery and the cost of maintaining it, but on the other hand it infuriates me to no end to know that if I had gone to the ER with a heart attack or diabetes because I was obese they would have covered the claims without a peep. That seems so wrong.

Much success,

Laura

243/145/140

DOB 10/1/05

Dr. Kuri, TJ

socalgal3 · September 16, 2007

I don't know anything about insurance because mine didn't cover banding at the time of my surgery(Kaiser). Now I guess they do in some areas. So, I went to Mexico and paid $8500 for my original procedure and $3500 + $250 (for the endoscopy) for my slip repair. They just repositioned my band-did not remove or replace it. I'm sorry you had such a bad experience. I hope all is well now! Best of health to you!

odanielle · September 16, 2007

Hi -- I spoke to my doctor about this - and he asked me "how would they know if a previous insurance (or co-insurance, like with a spouse) hadn't covered the claim? In other words, say you had a pace maker inserted with a previous insurer and then with your "new" insurance, you had problems with the pace maker -- unless there was a pre-existing insurance clause, wouldn't they be required to pay?

Either way, I would definitely appeal -- there are threads here and in Obesityhelp.com that talk about appealing through third parties - that seems to get better results.

Good luck!

GR8 · September 16, 2007

I have not had this situation - but am curious -- WHAT has caused the slipage for those of you that have had it.

Please get well soon! I am sure it is extremely SCARY!

insubordination · September 16, 2007

My condolences. The cost must be a very scary situation. I have put myself in the same position because I wanted the band so badly. If anything goes in the next 8 months requiring surgery, I will be paying it out of my own pocket (which is empty and then some).

LJBravado · September 16, 2007

I should have clarified - the insurance company doesn't seem to care who paid for the procedure originally - their policy is that the won't cover -anything- having to do with weight loss surgery. I will definitely appeal, and thanks to all for the suggestions! I still argue that the situation was an emergency, although that may hold more meaning for me than for them.

While it is definitely scary to face a possible $10k+ medical bill, I still wouldn't change a thing. For GR8 - my slip was undoubtably caused by too much vomiting. Although I can't say for sure when the slip began, I had several occasions where I'd be OK one day, and too restricted the next. My fill doc is 2.5 hours away, so I tended to be "OK" with vomiting more than I should have, not really heeding the warning that too much vomiting can cause a slip. I take responsibility for it, although they can happen without the vomiting, I would say that most slips are a result of vomiting. For anyone who thinks that it won't happen to them, think again!! I will say that the slip was FAR more painful than the original surgery. I will be very careful not to have it happen again, not to mention if it were to happen again, I might lose my band entirely, which would be devastating. I can't imagine not having it.

I'm so grateful for these message boards - thank God we all stick together. Heaven knows the insurance companies aren't necessarily looking out for us.

Much success!

Laura