changing insurances

sue72704 · March 12, 2005

Hi all,

I am wondering how changing health insurances works. The insurance that did my surgery was wonderful. Approved it the first time, (2days), and has paid for my 2 fills 100 percent. However now I am changing employment and my new insurance is Aenta. My questions are

1. If I have complications from my band (which was done in July 04 and I have not had any problems), will they cover any problems if any come up in the future

2. If Aenta does not cover the lap band will they cover the fills????????

I do plan on calling Aenta to ask, but can't do that until Monday.

By the way its cold up here in Maine, and we are expecting 16-24 inches of Snow tonight and tommorow. Nice huh???

Any comments will be helpful

Sue

the best me · March 12, 2005

Apparently, pre-existing condition clauses don't count when you have continuous coverage, or no gaps in coverage. Aetna should cover emergencies related to the band, but if the actual WLS is excluded, you may not have fill coverage. Definately talk to Aetna and get the scoop though. You may have to start a little "Band" savings account to cover out of pocket expenses not covered under your new plan. Please post your findings here! I am very interested in what you find out!

Alexandra · March 12, 2005

Kathy's right. New medical issues arising from the band should be covered as though they have arisen from any medically implanted device. Aetna doesn't evaluate whether they would have paid for the original implantation when they evaluate claims for complications down the line. It's not relevant to the current medical situation.

Whether they will pay for fills probably depends on the coding your doctor uses to submit the claim. If it's done in the office and he bills for an office visit, it could be covered. If it's done with a barium swallow and a fluoroscope that might be billed as something else. It's possible some of the charges would be paid and not whatever is charged for the actual injection, if the items are billed separately.

And, of course, a lot depends on your policy. Good luck! And you're very lucky to have been banded before switching to Aetna.