Jump to content

Hello! Welcome to the Largest Bariatric Surgery Community Online!

Welcome to BariatricPal.com, the largest weight loss surgery social network in the world! Our goal is to provide a unique platform for patients and potential patients alike that enables you to make informed choices involving your surgery decisions as well as providing you the support you need to meet your goals. Sign up now to access exclusive member features!

Join our community. It's free!

When self-pay who pays for complications?

4385
Views
Started by brittu, Jun 13, 2009 7:48 PM
15 replies to this topic
15 replies to this topic

    brittu

    Guru in Training

  • Posts: 206
  • Joined: May 2006
  • Location: WA
  • Surgery: Gastric Sleeve
  • Height: 5 feet 6 inches
  • Starting Weight: 256 lbs
  • Weight Lost: 100 lbs
  • Current Weight: 156 lbs
  • Goal Weight: 130 lbs
  • BMI: 25.2
Posted June 13, 2009 - 7:48 PM

#1
Hi all,

I'm just about to start my official fight with the insurance company (Fed BCBS) for denying coverage for revision to VSG after a lap band slip. I plan to have surgery with Dr. Aceves if I don't win on appeal and possibly if it looks like it's going to take too long (I've already gained back nearly half of the weight I lost). Here's my question...

I've read a few stories of VSGers who had a serious leak that required considerable hosptial time and medical care. This really concerns me when I think about self-pay - I assume this kind of care could run in the tens of thousands of dollars if not more. But who pays for this in the case of self-pay? Does the insurance refuse coverage?

Thanks!
Britt


    burnsun

    Junior Guru

  • Posts: 361
  • Joined: Jun 2004
  • Location: MO
  • Surgery: LAP-BAND
Posted June 13, 2009 - 8:43 PM

#2
my insurance paid for certain things...... the hospitalization, the anesthia and the dr except for the actual surgeon fees (4 k billed to insurance.....requied to pay 2850 ....the part insurance would have paid him) or his little followers fees unless it was hospital visit. I also had to pay my deductible 1500$ but my whole hospital stay was well over 100K ....I also had an emergency c-section too caused by the lap band issue and need for surgery......the covered all this too!


    Elisabethsew

    BariatricPal Host


  • Posts: 2,894
  • Joined: Apr 2006
  • Gender: Female
  • Location: USA
  • Surgery: Duodenal Switch
  • Height: 5 feet 1 inches
  • Weight Lost: 200 lbs
  • BMI: 47.2
  • My Blogs
Posted June 13, 2009 - 8:59 PM

#3
I believe any complications from VSG surgery done in Mexico are treated and covered by insurance in the U.S. If you have a leak while in Mexico, it is treated there. Dr. Aceves has done over 600 sleeves and has no leaks.


    burnsun

    Junior Guru

  • Posts: 361
  • Joined: Jun 2004
  • Location: MO
  • Surgery: LAP-BAND
Posted June 13, 2009 - 9:59 PM

#4
My policy here now reads no expenses to to any type of bariatric surgery (revision or fixes included). we have lost three appeals on getting them to pay for the parts they would not cover.....we even asked for the part i paid to come off the individual and family deductible....no luck.

Our state insurance commission said if they exclude bariatric surgert....they can exclude whatever the deem related to it.....in our case what came down to life saving for the baby they paid for.....because of our maternity contract.

ironically untill this last pregnancy....i had no problems....at goal and happy with my band and xrays and endo to prove it 1 month prior to conception

I was told that it varies from state to state and then based on how policy was written.

My dr here is making one last appeal...... but i am not holding out hope.

Edited by burnsun, June 13, 2009 - 10:03 PM.



    MacMadame

    Bariatric Legend

  • Posts: 4,236
  • Joined: Feb 2008
  • Location: CA
  • Surgery: LAP-BAND
  • Surgeon: Paul Cirangle
  • Surgery Date: Sep 2008
  • Height: 5 feet 1 inches
  • Starting Weight: 223
  • Weight Lost: 110
  • Current Weight: 113
  • Goal Weight: 115
  • BMI: 21.3
  • My Blogs
Posted June 13, 2009 - 11:38 PM

#5
I think it does vary from state to state but it also depends on how the policy is written and which company it is.

When I was going through this, I found that my insurance company was adamant that they would not pay to remove a band, if it slipped or eroded. But when I asked about the sleeve, they implied complications would be covered. They said a leak would be treated like an accident.

Also, most of the complications you can have from WLS are things that can happen to anyone, even if they didn't have surgery, so it's harder to deny them. For example, you can get a kidney stone or a blood clot at any time. Sure, surgery ups your risk, but they can't absolutely prove that surgery caused these things.

The leak is the only thing I can think of that is directly related to surgery and, even then, some insurance companies will cover it anyway. My surgeon says about 90% of his self-pays who get complications get them covered by insurance.

I still took out a home equity loan just in case prior to my surgery. (Well, I tried to anyway.... long story.) I figured that I might end up out of pocket by as much as 40K if I had a leak so I wanted to be prepared.


    Elisabethsew

    BariatricPal Host


  • Posts: 2,894
  • Joined: Apr 2006
  • Gender: Female
  • Location: USA
  • Surgery: Duodenal Switch
  • Height: 5 feet 1 inches
  • Weight Lost: 200 lbs
  • BMI: 47.2
  • My Blogs
Posted June 17, 2009 - 1:10 PM

#6
In N.Y. leaks are covered by insurance by nearly all carriers (got that info. from the billing dept. of the health care system I work for).


    Bandedbut

    Intermediate Member

  • Posts: 25
  • Joined: May 2007
  • Location: CA
  • Surgery: LAP-BAND
Posted August 26, 2009 - 11:32 PM

#7
I just posted a similar question in the insurance forum. I was a self pay banster, but was told insurance WOULD pay for complications. It hasn't covered an unfills due to dehydration though. There is no way I could pay for removal/revision right now, but can't live like this either.


    Oregondaisy

    BariatricPal Host


  • Posts: 10,748
  • Joined: Dec 2006
  • Gender: Female
  • Location: OREGON
  • Surgery: Gastric Sleeve
  • Surgeon: Alberto Aceves
  • Surgery Date: Apr 2009
  • Height: 5 feet 2 inches
  • Starting Weight: 237
  • Weight Lost: 102
  • Current Weight: 135
  • Goal Weight: 135
  • BMI: 24.7
  • My Blogs
Posted August 26, 2009 - 11:48 PM

#8
Thank goodness Dr. Aceves has never had a leak. I know complications are very expensive, but I trusted him so much, I wasn't worried about complications.


    SalesGirl711

    Bariatric Legend

  • Posts: 7,063
  • Joined: Mar 2007
  • Gender: Female
  • Location: AL
  • Surgery: LAP-BAND
  • Surgery Date: Apr 2007
  • Height: 6 feet 0 inches
  • Starting Weight: 333 lbs
  • Weight Lost: 85 lbs
  • Current Weight: 248 lbs
  • Goal Weight: 180 lbs
  • BMI: 33.6
  • My Blogs
Posted September 3, 2009 - 10:12 PM

#9

I just posted a similar question in the insurance forum. I was a self pay banster, but was told insurance WOULD pay for complications. It hasn't covered an unfills due to dehydration though. There is no way I could pay for removal/revision right now, but can't live like this either.

My insurance will not pay for ANY complications. The policy says they do not pay for anything related to obesity treatment, including complications.
I have had to have a surgery to fix, I had to have testing, etc. done; and my insurance is adamant, they will not pay. Even if the band was eroding, I would have to come up with the money myself.
Definitely call your insurance to confirm with them, as I know mine did not budge.


    TexasT

    Bariatric Guru

  • Posts: 400
  • Joined: Sep 2009
  • Gender: Female
  • Location: TEXAS
  • Surgery: LAP-BAND
  • Surgeon: Wade Barker
  • Surgery Date: Jan 2010
  • Height: 5 feet 4 inches
  • Starting Weight: 225
  • Weight Lost: 87
  • Current Weight: 138
  • Goal Weight: 140
  • BMI: 23.7
Posted September 11, 2009 - 11:50 AM

#10
If you have insurance you must check your policy. Mine will not pay for anything related to obesity help - no matter what. So I would to have to pay for anything to do with complications. My revision from band to sleeve surgery is scheduled for 10/30, and now I'm not even sure I'm going to go through with it. I'm self-pay, but am also have gallbladder removal, which is covered by insurance. My doc is charging me $5000 for the sleeve portion of the surgery. I'm just afraid of having to pay for complications if something were to happen.


0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users

Recent Status Updates

View All Updates

Topics with No Reply