No Insurance Coverage for Complications???

[Jeen423 0]

Hi all,

I'm paying for my surgery myself but I just found out that my insurance company will NOT cover any complications from my Lap-Band surgery. Has anyone else had to make this decision? I'm freaking. I'm finally ready to do this but having to pay for emergency treatment could ruin us financially.

Please give me some input.

Thanks!

[princess_sophie 0]

Jeen423,

I will be self-pay also. I don't know if my insurance will cover complications from the surgery, but more than likely they won't. I hesitate to call them and ask because when I called and gave the cpt codes for the lap band they said it was covered, but when it was submitted for approval, the dr.'s office was told that it was an exclusion. I talked to my work and they don't know why UHC said that it was covered, but it isn't and never has been. I'm afraid if I called and asked about complications it would be a 50/50 chance that they tell me the wrong thing.

It is a very difficult decision. I've already had an ultra sound on my abdomen and liver and I'm scheduled for a nutrition class and a psych eval. All of this was done when I thought the surgery was going to be covered. One minute I'm positive I'm going to do it and the next I have all of these fears and doubts. What if something goes wrong during surgery? What if I have complications 6 months out? What if I fail at this like I have with everything else I've tried, only this time I will have all of this debt on top of the failure?

I wish I could say something that would help, but I think I'm feeling the same way you are. :confused2:

PS

[Jeen423 0]

Dear PS,

It really is scary isn't it? I have the same fears. I have spent half the day walking around in a daze. Do I get the surgery or not? But I think I have decided with my heart so I probably need to just keep plowing ahead and have some faith that things are going to be O.K.

I can envision myself being able to do things I haven't been able to do for years and that kind of snaps me back to the crux of the matter - quality of life. I can either stuggle on grunting when I tie my shoes, hurting myself to keep up with my husband on a walk, not being able to play tennis or even throw a baseball with my grandkids, or I can do this and not look back.

I hope both of our struggles with this ends happily!

Jeen423

[Wheetsin 714]

I had full insurance approval so I can't speak from my personal experience, but I know a few who were self-pay and complications were NOT covered at all. Not for any of them. I don't know if it's lumped into a "pre-existing condition" (and therefore exlcudable) or not, you'd have to ask your insurance company.

[VegasGrace 1]

Well, that's tricky.

A slip, erosion, anything related directly to the band...of course they won't pay.

But...malnutrition and need potassium supplement...sure.

Pneumonia and flu alot because of weakened immunity...sure.

Ulcer, sure.

These things are 'diet' related and not band related.

So, something lifethreatening..sure, they'll cover it. But if it has to do with physically touching the band...no, I don't think they will.

[princess_sophie 0]

Wheetsin,

Can you share the specifics of the complications that were not covered for the people you know?

My insurance has an exclusion for any obesity treatment, surgery or non surgery. As long as whatever medical procedure or treatment I have is submitted without obesity or weight mentioned, it would be covered. I hate to be sneaky like that, but....

Jeen423,

I know what you mean. I often think I would rather just go ahead and die than continue to live the way I am now. And if I don't lose weight, I will probably die a very slow and painful death. With my health problems and complications from my long list of health problems, getting worse every year. And then I will have this little thought, but can I do it on my own? and for a moment I think I can, if I just try harder. But then I quickly remember that I've been trying and failing to lose weight, for over 30 years. Not only failing to lose, but being very successful at gaining. I started out at 11, thinking I was fat, starting crash dieting, which lead to bingeing and it has been down hill, or rather the scale has gone up, ever since. The really sad thing is that when I look back at pictures from when I was 11, I wasn't fat at all, I was just starting to develop.

I wish you the very best.

PS